Provider Demographics
NPI:1215975206
Name:CROMER, DORIS D (MD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:D
Last Name:CROMER
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 1:8 ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2166
Mailing Address - Country:US
Mailing Address - Phone:603-997-6466
Mailing Address - Fax:
Practice Address - Street 1:AMERICAN WELL
Practice Address - Street 2:75 STATE STREET 26TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:855-347-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13531207Q00000X
MEMD20157207Q00000X
MDD56959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME142350002Medicaid
MD688801100Medicaid
NH1215975206Medicaid
NH30207960Medicaid
ME142350002Medicaid
CB9865Medicare UPIN
P00608085Medicare PIN
NH30207960Medicaid
MD700LB403Medicare PIN