Provider Demographics
NPI:1336142595
Name:CROWLEY, HEATHER LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LORRAINE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAMPTON RD
Mailing Address - Street 2:UNIT 208
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4849
Mailing Address - Country:US
Mailing Address - Phone:603-778-8522
Mailing Address - Fax:603-778-1602
Practice Address - Street 1:1 HAMPTON RD
Practice Address - Street 2:UNIT 208
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4849
Practice Address - Country:US
Practice Address - Phone:603-778-8522
Practice Address - Fax:603-778-1602
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11901207ZC0500X, 207ZP0102X
MA209819207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203605Medicaid
MA2011468Medicaid
NH30203605Medicaid
MACRA35456Medicare ID - Type Unspecified
NHCRRE7220Medicare ID - Type Unspecified