Basic Information
Provider Information
NPI: 1740541697
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CROWDER
FirstName: AMBER
MiddleName: RACHELLE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 780453
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191780453
CountryCode: US
TelephoneNumber: 3033067783
FaxNumber: 3033067753
Practice Location
Address1: 9395 CROWN CREST BLVD
Address2:  
City: PARKER
State: CO
PostalCode: 801388573
CountryCode: US
TelephoneNumber: 3032694000
FaxNumber: 3033067753
Other Information
ProviderEnumerationDate: 06/06/2012
LastUpdateDate: 07/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000XDR.0063194COY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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