Provider Demographics
NPI:1679238166
Name:BLAKEY, CRANSTON CHRISTOPHER (TM)
Entity Type:Individual
Prefix:MR
First Name:CRANSTON
Middle Name:CHRISTOPHER
Last Name:BLAKEY
Suffix:
Gender:M
Credentials:TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 SWIFT RUN RD
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-2360
Mailing Address - Country:US
Mailing Address - Phone:434-242-4468
Mailing Address - Fax:
Practice Address - Street 1:1943 SWIFT RUN RD
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-2360
Practice Address - Country:US
Practice Address - Phone:434-242-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAE24690952172A00000X
VA
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No172A00000XOther Service ProvidersDriverGroup - Single Specialty