Provider Demographics
NPI:1376974196
Name:KRANE, BRYN M (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:M
Last Name:KRANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3743
Mailing Address - Country:US
Mailing Address - Phone:410-268-8862
Mailing Address - Fax:410-268-0380
Practice Address - Street 1:2000 MEDICAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3743
Practice Address - Country:US
Practice Address - Phone:410-268-8862
Practice Address - Fax:410-268-0380
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056605363A00000X
MDC06125207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA328304Medicare PIN