Provider Demographics
NPI:1932108768
Name:CROWDER, ROBERT L (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:CROWDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64531
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4531
Mailing Address - Country:US
Mailing Address - Phone:410-280-6568
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2720
Practice Address - Fax:410-224-0209
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002641363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
D66570OtherMEDICAL LICENSE
0045OtherBCBS-DC
1831164342OtherNPI NUMBER
227069787OtherCHAMPUS/TRICARE PGBA
I28465OtherUPIN
MD413802300Medicaid
7736577OtherAETNA
1697390OtherAETNA/US HEALTHCARE HMO
92322401OtherBCBS-MD
MD413802300Medicaid
P89964Medicare UPIN