Provider Demographics
NPI:1952589392
Name:CROWE, MARY K (DO)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:CROWE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5515 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2695
Mailing Address - Country:US
Mailing Address - Phone:814-868-8294
Mailing Address - Fax:814-868-2489
Practice Address - Street 1:5515 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2695
Practice Address - Country:US
Practice Address - Phone:814-868-8294
Practice Address - Fax:814-868-2489
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002704363A00000X
PAOT019106207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952589392Medicaid
VA10113082POtherSENTARA HEALTH PLANS
VA1952589392OtherTRICARE
VAVV4477BMedicare PIN
VA1952589392Medicaid