Provider Demographics
NPI:1922067727
Name:CRANBROOK PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:CRANBROOK PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:R STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:336-885-4800
Mailing Address - Street 1:1231 EASTCHESTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3103
Mailing Address - Country:US
Mailing Address - Phone:336-885-4800
Mailing Address - Fax:336-885-4810
Practice Address - Street 1:1231 EASTCHESTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3103
Practice Address - Country:US
Practice Address - Phone:336-885-4800
Practice Address - Fax:336-885-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014E8Medicaid
NC89014E8Medicaid