Basic Information
| Provider Information | |||||||||
| NPI: | 1356685499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWDER | ||||||||
| FirstName: | ALLEN | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2331 FRANKLIN RD SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407251226 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2331 FRANKLIN RD SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407251226 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110004077 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 0110004077 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1356685499 | 01 | VA | ANTHEM MEDIGAP | OTHER | 1356685499 | 01 | VA | CCC VIRGINIA PREMIER | OTHER | 1356685499 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 1356685499 | 01 | VA | MEDICAID QMB | OTHER | 1356685499 | 01 | VA | HUMANA MEDICARE | OTHER | 371194700 | 01 | VA | BLACK LUNG | OTHER | P01201634 | 01 | VA | RAILROAD MEDICARE | OTHER | 1356685499 | 01 | VA | SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY | OTHER | 1356685499 | 01 | VA | AETNA | OTHER | 1356685499 | 01 | VA | INTOTAL | OTHER | 1356685499 | 01 | VA | UMWA | OTHER | 1356685499 | 01 | VA | TRICARE | OTHER |