Provider Demographics
NPI:1154584829
Name:CRUMPLER, FAITH MARY (MD)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:MARY
Last Name:CRUMPLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:329 PRIMROSE RD FL 2
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4093
Practice Address - Country:US
Practice Address - Phone:650-288-1200
Practice Address - Fax:650-288-4180
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315037548207Q00000X
CAA115514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine