Provider Demographics
NPI:1598840126
Name:DAVID E. CRANDALL, DO, INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:DAVID E. CRANDALL, DO, INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCOIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-862-6849
Mailing Address - Street 1:1 ARH LANE, SUITE 200
Mailing Address - Street 2:PO BOX 217
Mailing Address - City:LOW MOOR
Mailing Address - State:VA
Mailing Address - Zip Code:24457
Mailing Address - Country:US
Mailing Address - Phone:540-862-3335
Mailing Address - Fax:540-862-6597
Practice Address - Street 1:1 ARH LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-3335
Practice Address - Fax:540-862-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE53306Medicare UPIN
VAC08409Medicare ID - Type Unspecified