Provider Demographics
NPI:1063740355
Name:DULANEY-CRIPE, ELIZABETH MACKENZIE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MACKENZIE
Last Name:DULANEY-CRIPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3737 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1262
Mailing Address - Country:US
Mailing Address - Phone:937-433-5309
Mailing Address - Fax:937-298-0287
Practice Address - Street 1:3737 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1262
Practice Address - Country:US
Practice Address - Phone:937-433-5309
Practice Address - Fax:937-298-0287
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.129109207X00000X
GA073391207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0175066Medicaid
OHH449450Medicare PIN