Provider Demographics
NPI:1225151244
Name:CROTTY, MICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CROTTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PLUMTREE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6095
Mailing Address - Country:US
Mailing Address - Phone:410-569-4224
Mailing Address - Fax:410-569-4368
Practice Address - Street 1:104 PLUMTREE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-569-4224
Practice Address - Fax:410-569-4368
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical