Provider Demographics
NPI:1942219746
Name:CRANNY, JENNIFER RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTH
Last Name:CRANNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:NEWCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 118008
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:843-407-0551
Mailing Address - Fax:843-376-2680
Practice Address - Street 1:3010 TRENWEST DR STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3208
Practice Address - Country:US
Practice Address - Phone:336-970-5300
Practice Address - Fax:336-970-5298
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCME283142085N0904X, 2085B0100X, 2085P0229X, 2085R0204X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC283142Medicaid
SC283142Medicaid
SCSC22537499Medicare PIN
SCSC22536834Medicare PIN
SCSC22537126Medicare PIN
SCSC22537006Medicare PIN
SCSC22536868Medicare PIN
H19948Medicare UPIN
SCSC22535281Medicare PIN