Provider Demographics
NPI:1215901616
Name:CROTSER, CONLETH MARIE CROWLEY (MD)
Entity type:Individual
Prefix:
First Name:CONLETH
Middle Name:MARIE CROWLEY
Last Name:CROTSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6681 RIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-842-9873
Mailing Address - Fax:440-842-5676
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-842-9873
Practice Address - Fax:440-842-5676
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062165C208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0841352Medicaid
C83401Medicare UPIN
OH0841352Medicaid