Provider Demographics
NPI:1497857395
Name:CROWLEY, DONNA MARIE (MD)
Entity Type:Individual
Prefix:MR
First Name:DONNA
Middle Name:MARIE
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 1:655 EUCLID AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2957
Mailing Address - Country:US
Mailing Address - Phone:619-267-9450
Mailing Address - Fax:619-267-9458
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:STE 209
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-267-9450
Practice Address - Fax:619-267-9458
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62894208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G62894Medicaid
D16435Medicare UPIN
CA00G62894Medicaid