Healthcare Provider Details

I. General information

NPI: 1275520629
Provider Name (Legal Business Name): TAMERA D CROWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TECHNOLOGY AVE
NEW ALBANY IN
47150-8548
US

IV. Provider business mailing address

4101 TECHNOLOGY AVE
NEW ALBANY IN
47150-8548
US

V. Phone/Fax

Practice location:
  • Phone: 812-941-4500
  • Fax: 812-941-4506
Mailing address:
  • Phone: 812-941-4500
  • Fax: 812-941-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number30557
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01073185A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: