Provider Demographics
NPI:1356685499
Name:CROWDER, ALLEN WAYNE (PA)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:WAYNE
Last Name:CROWDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004077363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356685499OtherANTHEM MEDIGAP
VA1356685499OtherCCC VIRGINIA PREMIER
VA1356685499OtherOPTIMA HEALTH PLAN
VA1356685499OtherMEDICAID QMB
VA1356685499OtherHUMANA MEDICARE
VA371194700OtherBLACK LUNG
VAP01201634OtherRAILROAD MEDICARE
VA1356685499OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1356685499OtherAETNA
VA1356685499OtherINTOTAL
VA1356685499OtherUMWA
VA1356685499OtherTRICARE
VA371194700OtherBLACK LUNG