MEDICARE: DR. WAYNE L CROWDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	D0017794	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538163308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE L CROWDER M.D.

Provider Business Mailing Address
First Line	:	1475 TANEY AVE
Second Line	:	STE 201
City	:	FREDERICK
State	:	MD
Zip	:	21702-5126
Country	:	US
Telephone Number	:	301-662-0133
Fax Number	:	240-379-6710

Provider Business Practice Location Address
First Line	:	1475 TANEY AVE
Second Line	:	STE 201
City	:	FREDERICK
State	:	MD
Zip	:	21702-5126
Country	:	US
Telephone Number	:	301-662-0133
Fax Number	:	240-679-6710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/18/2010

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