Basic Information
Provider Information
NPI: 1124451380
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CROWDER
FirstName: MARGARET
MiddleName: MARY
NamePrefix: MS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 412503
Address2:  
City: BOSTON
State: MA
PostalCode: 022412503
CountryCode: US
TelephoneNumber: 6177263884
FaxNumber:  
Practice Location
Address1: 15 OLD ROLLINSFORD RD STE 302
Address2:  
City: DOVER
State: NH
PostalCode: 038202819
CountryCode: US
TelephoneNumber: 6037429200
FaxNumber: 6037424605
Other Information
ProviderEnumerationDate: 08/12/2013
LastUpdateDate: 12/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X061457-23NHN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LP0808X061457-23NHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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