Provider Demographics
NPI:1013096486
Name:CRANE, RICHARD DENTON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DENTON
Last Name:CRANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3350
Mailing Address - Country:US
Mailing Address - Phone:910-754-8921
Mailing Address - Fax:910-754-7140
Practice Address - Street 1:16 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-3350
Practice Address - Country:US
Practice Address - Phone:910-754-8921
Practice Address - Fax:910-754-7140
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9700913OtherMEDICAL LICENSE NUMBER
NC891053WMedicaid
SC18177OtherLICENSE NUMBER
NCP00053635OtherRAILROAD MEDICARE
NC891053WMedicaid
NC2236841BMedicare ID - Type Unspecified