1033651039 NPI number — DR. VALDA REGINA CROWDER MD

Table of content: DR. VALDA REGINA CROWDER MD (NPI 1033651039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033651039 NPI number — DR. VALDA REGINA CROWDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWDER
Provider First Name:
VALDA
Provider Middle Name:
REGINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1033651039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 LONDONDERRY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17109-5317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-988-0000
Provider Business Mailing Address Fax Number:
717-782-5716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10411 MOTOR CITY DR STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-669-1607
Provider Business Practice Location Address Fax Number:
202-403-3317
Provider Enumeration Date:
11/08/2016

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: 207P00000X , with the licence number:  TMD005231 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 0101058531 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 19346 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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