1548298110 NPI number — KERMIT P CROWDER MD

Table of content: KERMIT P CROWDER MD (NPI 1548298110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548298110 NPI number — KERMIT P CROWDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWDER
Provider First Name:
KERMIT
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548298110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2041 GEORGIA AVE NW STE 6101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20060-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-865-6679
Provider Business Mailing Address Fax Number:
202-865-3138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2041 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20060-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-865-1571
Provider Business Practice Location Address Fax Number:
202-865-3285
Provider Enumeration Date:
06/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD33665 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010176425 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 408040800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036830100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".