Provider Demographics
NPI:1952494544
Name:CROWLEY, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
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:P. O. BOX 8676
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8676
Mailing Address - Country:US
Mailing Address - Phone:864-232-7338
Mailing Address - Fax:864-239-6645
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE B200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-232-7338
Practice Address - Fax:864-239-6645
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11929207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11925Medicaid
SCA923241874Medicare PIN
SCA92324Medicare UPIN