1891773073 NPI number — DR. ROSE CROWLEY CHRISTIAN MD

Table of content: DR. ROSE CROWLEY CHRISTIAN MD (NPI 1891773073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891773073 NPI number — DR. ROSE CROWLEY CHRISTIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIAN
Provider First Name:
ROSE
Provider Middle Name:
CROWLEY
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:
CROWLEY
Provider Other First Name:
ROSE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891773073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1063
Provider Second Line Business Mailing Address:
FLETCHER ALLEN HEALTH CARE
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05402-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-847-4576
Provider Business Mailing Address Fax Number:
802-847-2226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 S PROSPECT ST
Provider Second Line Business Practice Location Address:
DEPT OF ENDOCRINOLOGY
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-4576
Provider Business Practice Location Address Fax Number:
802-847-2226
Provider Enumeration Date:
01/06/2006

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: 207RE0101X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1011777 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com