Provider Demographics
NPI:1679511075
Name:CROWLEY, KERRY (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:CROWLEY
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 1:50 UNION ST
Mailing Address - Street 2:ELEANOR WIDENER DIXON MEMORIAL CLINIC
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-963-4066
Mailing Address - Fax:207-963-7723
Practice Address - Street 1:37 CLINIC RD
Practice Address - Street 2:ELEANOR WIDENER DIXON MEMORIAL CLINIC
Practice Address - City:GOULDSBORO
Practice Address - State:ME
Practice Address - Zip Code:04607-4013
Practice Address - Country:US
Practice Address - Phone:207-963-4066
Practice Address - Fax:207-963-7723
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED77086Medicare UPIN
ME015766Medicare PIN
ME01576601Medicare PIN
ME01576602Medicare PIN