Provider Demographics
NPI:1881346062
Name:CRANER, SAMANTHA A (PA-C, RT(R))
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:CRANER
Suffix:
Gender:F
Credentials:PA-C, RT(R)
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:GRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)
Mailing Address - Street 1:1656 CHAMPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4830
Mailing Address - Country:US
Mailing Address - Phone:315-624-6293
Mailing Address - Fax:
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-624-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8636342085R0204X
NY030134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology