Provider Demographics
NPI:1033217146
Name:CRANDALL, MARGOT J (MD)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:J
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGOT
Other - Middle Name:J
Other - Last Name:CRANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:221 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2526
Mailing Address - Country:US
Mailing Address - Phone:808-244-9056
Mailing Address - Fax:
Practice Address - Street 1:221 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2526
Practice Address - Country:US
Practice Address - Phone:808-244-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25628207R00000X
CODR.52638207R00000X
HIMD-11935208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25628OtherAZ STATE MEDICAL LICENSE
AZ471904Medicaid
CO023818OtherKAISER COMMERCIAL NUMBER
CO53284364Medicaid
AZ1033217146OtherBCBSAZ
AZZ115078Medicare PIN
CO303828YK5YMedicare PIN
AZ25628OtherAZ STATE MEDICAL LICENSE