| Mark W Crandall Mdpa | |
|
11421 Reisterstown Rd Owings Mills MD 21117-1834 | |
| (410) 356-2884 | |
| (410) 833-8174 |
| Full Name | Mark W Crandall Mdpa |
|---|---|
| Speciality | Clinic/Center |
| Location | 11421 Reisterstown Rd, Owings Mills, Maryland |
| Authorized Official Name and Position | Mark W Crandall (PRESIDENT) |
| Authorized Official Contact | 4103562884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark W Crandall Mdpa 11421 Reisterstown Rd Owings Mills MD 21117-1834 Ph: (410) 356-2884 | Mark W Crandall Mdpa 11421 Reisterstown Rd Owings Mills MD 21117-1834 Ph: (410) 356-2884 |
| NPI Number | 1568618072 |
|---|---|
| Provider Enumeration Date | 08/15/2008 |
| Last Update Date | 08/15/2008 |
| Medicare PECOS PAC ID | 7214002393 |
|---|---|
| Medicare Enrollment ID | O20080825000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568618072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mark W Crandall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841333531 PECOS PAC ID: 6608940739 Enrollment ID: I20080807000077 |
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