Basic Information
| Provider Information | |||||||||
| NPI: | 1417033325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | MERLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16310 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284086310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107429243 | ||||||||
| FaxNumber: | 8887461787 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 DUTCH FORK RD | ||||||||
| Address2: | |||||||||
| City: | CHAPIN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290367576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107429243 | ||||||||
| FaxNumber: | 8887461787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 19920 | SC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084F0202X | 19920 | SC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | T39189 | 05 | SC | MEDICAID |