Basic Information
| Provider Information | |||||||||
| NPI: | 1336142595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWLEY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LORRAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HAMPTON RD | ||||||||
| Address2: | UNIT 208 | ||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038334849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037788522 | ||||||||
| FaxNumber: | 6037781602 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HAMPTON RD | ||||||||
| Address2: | UNIT 208 | ||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038334849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037788522 | ||||||||
| FaxNumber: | 6037781602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 11901 | NH | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZC0500X | 209819 | MA | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 11901 | NH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 209819 | MA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 30203605 | 05 | NH | MEDICAID | 2011468 | 05 | MA | MEDICAID |