Crandell, Jason Malcolm

Crandell, Jason Malcolm is an sole proprietor health care provider with primary practice located at 2511 Neudorf Rd Ste D , Clemmons NC 27012-8922. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Crandell, Jason Malcolm can be contacted via phone (336) 778-0506.

Contact Information

Primary practice address
2511 Neudorf Rd Ste D Clemmons NC 27012-8922
Phone: (336) 778-0506
Fax: (336) 778-0570
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 23500 North Carolina

Profile Details

NPI number 1255349098
LBN Legal business name Crandell, Jason Malcolm
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 4th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255349098 NPPES
North Carolina Other 73006 MEDCOST
North Carolina MEDICAID 8925220 MEDCOST
North Carolina Other MR109 MEDCOST
North Carolina Other 05667001 MEDCOST
North Carolina Other 1504998 MEDCOST

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