Healthcare Provider Details

I. General information

NPI: 1215901616
Provider Name (Legal Business Name): CONLETH MARIE CROWLEY CROTSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6681 RIDGE RD SUITE 205
PARMA OH
44129-5713
US

IV. Provider business mailing address

6681 RIDGE RD SUITE 205
PARMA OH
44129-5713
US

V. Phone/Fax

Practice location:
  • Phone: 440-842-9873
  • Fax: 440-842-5676
Mailing address:
  • Phone: 440-842-9873
  • Fax: 440-842-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35062165C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: