Provider Demographics
NPI:1407851371
Name:CROWLEY, TIMOTHY M (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 BELLEMEADE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0682
Mailing Address - Country:US
Mailing Address - Phone:812-474-1010
Mailing Address - Fax:812-485-2476
Practice Address - Street 1:4405 BELLEMEADE AVE
Practice Address - Street 2:STE 101
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0682
Practice Address - Country:US
Practice Address - Phone:812-474-1010
Practice Address - Fax:812-485-2476
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029433207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200316700Medicaid
IN231380OtherMEDICARE
IN180040683OtherRAILROAD MEDICARE
IN000000181187OtherANTHEM
IN3959300001Medicare NSC