Provider Demographics
NPI:1053391698
Name:CRANDALL, DAVID E (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MCCORMICK BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:24422-1037
Mailing Address - Country:US
Mailing Address - Phone:540-862-4205
Mailing Address - Fax:
Practice Address - Street 1:901 MCCORMICK BLVD
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-1037
Practice Address - Country:US
Practice Address - Phone:540-862-4205
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5877997Medicaid
VAE53306Medicare UPIN