Provider Demographics
NPI:1760796742
Name:MARK E. CRANE MD, LLC
Entity Type:Organization
Organization Name:MARK E. CRANE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-223-4311
Mailing Address - Street 1:286 HOSPITAL LOOP RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:286 HOSPITAL LOOP RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8497
Practice Address - Country:US
Practice Address - Phone:802-223-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0016453Medicare PIN