Provider Demographics
NPI:1740368679
Name:CROWDER, RICHARD FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:FREDERICK
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 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16186 MAIN RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:TANGIER
Practice Address - State:VA
Practice Address - Zip Code:23440
Practice Address - Country:US
Practice Address - Phone:757-891-2412
Practice Address - Fax:757-891-2493
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09602Medicare UPIN
VA1740368679Medicaid
VA015375R53Medicare PIN
VAP00377906Medicare PIN