Provider Demographics
NPI:1184666927
Name:CRANE, DOUGLAS F (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:F
Last Name:CRANE
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 1:164 WACCAMAW MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8903
Mailing Address - Country:US
Mailing Address - Phone:843-347-5060
Mailing Address - Fax:843-347-3959
Practice Address - Street 1:105 WAPPOO CREEK DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2134
Practice Address - Country:US
Practice Address - Phone:843-795-3585
Practice Address - Fax:843-795-9728
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC78082084A0401X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC078089Medicaid
SC5866OtherMEDICARE PIN FOR LOWCOUNTRY PSYCHOTHERAPY ASSOCIATES
SC7808OtherLICENSE NUMBER
GA030740OtherPHYSICIAN LICENSE
SC3344OtherMEDICARE PIN WACCAMAW CENTER FOR MENTAL HEALTH
SC3344OtherMEDICARE PIN WACCAMAW CENTER FOR MENTAL HEALTH
SC078089Medicaid