Provider Demographics
NPI:1285627141
Name:CROWE, STEPHEN NATHANIEL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NATHANIEL
Last Name:CROWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3678 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9096
Mailing Address - Country:US
Mailing Address - Phone:330-702-1396
Mailing Address - Fax:
Practice Address - Street 1:721 BOARDMAN POLAND RD
Practice Address - Street 2:# 204
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5107
Practice Address - Country:US
Practice Address - Phone:330-965-0220
Practice Address - Fax:330-965-9622
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2488151Medicaid
GAH05164Medicare UPIN