Healthcare Provider Details

I. General information

NPI: 1124025606
Provider Name (Legal Business Name): TIMOTHY CROWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST STE 208
ARLINGTON MA
02476-4738
US

IV. Provider business mailing address

22 MILL ST STE 208
ARLINGTON MA
02476-4784
US

V. Phone/Fax

Practice location:
  • Phone: 781-646-2848
  • Fax: 781-643-4308
Mailing address:
  • Phone: 781-646-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72550
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: