Provider Demographics
NPI:1639330723
Name:CRANDALL, DAVID BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:CRANDALL
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 1:3252 GLADE PIKE
Mailing Address - Street 2:
Mailing Address - City:MANNS CHOICE
Mailing Address - State:PA
Mailing Address - Zip Code:15550-7744
Mailing Address - Country:US
Mailing Address - Phone:814-623-4068
Mailing Address - Fax:
Practice Address - Street 1:3252 GLADE PIKE
Practice Address - Street 2:
Practice Address - City:MANNS CHOICE
Practice Address - State:PA
Practice Address - Zip Code:15550-7744
Practice Address - Country:US
Practice Address - Phone:814-623-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.049161208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery