Provider Demographics
NPI:1245296250
Name:CROWE, ELLEN B (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:CROWE
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 1:115 LOS PADRES DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1317
Mailing Address - Country:US
Mailing Address - Phone:805-380-3313
Mailing Address - Fax:805-449-0091
Practice Address - Street 1:115 LOS PADRES DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1317
Practice Address - Country:US
Practice Address - Phone:805-380-3313
Practice Address - Fax:805-449-0091
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036964207PE0004X
CAG89024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00608083OtherRAIL ROAD MEDICARE
MI104748978Medicaid
IN000000365275OtherANTHEM
IN200072690Medicaid
IN200072690Medicaid
MI104748978Medicaid