Healthcare Provider Details

I. General information

NPI: 1932108768
Provider Name (Legal Business Name): ROBERT L CROWDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY SUITE 430
ANNAPOLIS MD
21401-3046
US

IV. Provider business mailing address

PO BOX 64531
BALTIMORE MD
21264-4531
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-2720
  • Fax: 410-224-0209
Mailing address:
  • Phone: 410-280-6568
  • Fax: 410-280-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0002641
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: