Provider Demographics
NPI:1942205331
Name:CROTTY, MAUREEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:CROTTY
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 1:2 MEEHAN LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1413
Mailing Address - Country:US
Mailing Address - Phone:401-658-2525
Mailing Address - Fax:401-658-3031
Practice Address - Street 1:2 MEEHAN LN
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1413
Practice Address - Country:US
Practice Address - Phone:401-658-2525
Practice Address - Fax:401-658-3031
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160394208000000X
RIMD09809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006479Medicaid
RIPY01057Medicaid
RI7006479Medicaid