Provider Demographics
NPI:1285806869
Name:CHARLES H. CROFT M.D.,P.A.
Entity type:Organization
Organization Name:CHARLES H. CROFT M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-722-3288
Mailing Address - Street 1:1402 OAT ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3113
Mailing Address - Country:US
Mailing Address - Phone:321-722-3288
Mailing Address - Fax:321-722-3468
Practice Address - Street 1:1402 OAK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3113
Practice Address - Country:US
Practice Address - Phone:321-722-3288
Practice Address - Fax:321-722-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3121Medicare PIN