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General NPI Number Information
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NPI Number | 1710274097
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Entity Type | Organization
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Legal Business Name | WOOSTER UROLOGY LLC
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 546 WINTER ST SUITE 210
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City | WOOSTER
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State | OH
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Zip | 44691-2300
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Country | US
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Telephone | 330-345-5533
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Fax | 330-345-7659
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Provider Business Mailing Address
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Address Line | 546 WINTER ST SUITE 210
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City | WOOSTER
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State | OH
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Zip | 44691-2300
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Country | US
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Telephone | 330-345-5533
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Fax | 330-345-7659
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. PAUL J CROWLEY
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Credential | M.D.
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Telephone | 330-345-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35-090639
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 57530
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 35-090639
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 57530
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License Number State | OH
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