Provider Demographics
NPI:1093778227
Name:CRENSHAW, BRIAN SANDERS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SANDERS
Last Name:CRENSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7619
Mailing Address - Country:US
Mailing Address - Phone:336-273-7900
Mailing Address - Fax:336-275-0433
Practice Address - Street 1:3200 NORTHLINE AVE STE 250
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7619
Practice Address - Country:US
Practice Address - Phone:336-273-7900
Practice Address - Fax:336-275-0433
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35619207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7963OtherPARTNERS MEDICARE PROVIDE
NC5175428OtherAETNA PROVIDER NUMBER
NC1089LOtherBCBS NC PROVIDER NUMBER
NC75907OtherMEDCOST PROVIDER NUMBER
NC8925647Medicaid
NC75907OtherMEDCOST PROVIDER NUMBER
F94621Medicare UPIN