1902826738 NPI number — MR. MICHAEL J CROWE III DPM

Table of content: MR. MICHAEL J CROWE III DPM (NPI 1902826738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902826738 NPI number — MR. MICHAEL J CROWE III DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWE
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
DPM
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:
1902826738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 ALDEN ROAD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FAIRHAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02719-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-997-4646
Provider Business Mailing Address Fax Number:
508-991-5385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 ALDEN ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAIRHAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02719-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-997-4646
Provider Business Practice Location Address Fax Number:
508-991-5385
Provider Enumeration Date:
07/21/2006

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: 213E00000X , with the licence number:  1719 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0361143 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4358650 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 70263 . This is a "BCBS RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042882878 . This is a "FEDERAL TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33052 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480004429 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417187004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 721998 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y70786 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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