Provider Demographics
NPI:1710274097
Name:WOOSTER UROLOGY LLC
Entity Type:Organization
Organization Name:WOOSTER UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-345-5533
Mailing Address - Street 1:546 WINTER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2300
Mailing Address - Country:US
Mailing Address - Phone:330-345-5533
Mailing Address - Fax:330-345-7659
Practice Address - Street 1:546 WINTER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2300
Practice Address - Country:US
Practice Address - Phone:330-345-5533
Practice Address - Fax:330-345-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57530208800000X, 2088P0231X
OH35-090639208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2995497Medicaid
0624801OtherMEDICARE PTAN
4266321OtherMEDICARE PTAN
OH0714954Medicaid
OHC51967Medicare UPIN