Healthcare Provider Details

I. General information

NPI: 1639212350
Provider Name (Legal Business Name): BERNADETTE A CROWDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNADETTE A CROWDER MD

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W ROGERS AVE
BALTIMORE MD
21209-4545
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-8000
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP18628
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number050421
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0065945
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: