Provider Demographics
NPI:1891811493
Name:CROWDER, CLAYTON L (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:L
Last Name:CROWDER
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 1:115 ASHBY COURT
Mailing Address - Street 2:
Mailing Address - City:MT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3345
Mailing Address - Country:US
Mailing Address - Phone:856-638-0686
Mailing Address - Fax:
Practice Address - Street 1:1931 CHURCH LANE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-805-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021334E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7605200Medicaid
011401Medicare ID - Type Unspecified
PA7605200Medicaid