MEDICARE: CONLETH MARIE CROWLEY CROTSER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35062165C	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215901616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONLETH MARIE CROWLEY CROTSER MD

Provider Business Mailing Address
First Line	:	6681 RIDGE RD
Second Line	:	SUITE 205
City	:	PARMA
State	:	OH
Zip	:	44129-5713
Country	:	US
Telephone Number	:	440-842-9873
Fax Number	:	440-842-5676

Provider Business Practice Location Address
First Line	:	6681 RIDGE RD
Second Line	:	SUITE 205
City	:	PARMA
State	:	OH
Zip	:	44129-5713
Country	:	US
Telephone Number	:	440-842-9873
Fax Number	:	440-842-5676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	05/17/2011

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