Provider Demographics
NPI:1699755611
Name:CRICKARD, ELIZABETH ANN (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:CRICKARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6051 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-799-6044
Mailing Address - Fax:614-799-6088
Practice Address - Street 1:6051 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8218
Practice Address - Country:US
Practice Address - Phone:614-799-6044
Practice Address - Fax:614-799-6088
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005630208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964194Medicaid