Provider Demographics
NPI:1821137738
Name:JOANNE CRENSHAW, MD PC
Entity Type:Organization
Organization Name:JOANNE CRENSHAW, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-766-6165
Mailing Address - Street 1:47568 ANCHORAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4712
Mailing Address - Country:US
Mailing Address - Phone:703-421-2875
Mailing Address - Fax:703-421-5701
Practice Address - Street 1:21135 WHITFIELD PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7279
Practice Address - Country:US
Practice Address - Phone:703-766-6165
Practice Address - Fax:703-444-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08787Medicare PIN