MEDICARE: DR. KENNETH M CRANDALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	D0083337	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D0083337	OTHER	MD	MARYLAND LICENSE

General Provider Information

NPI Number	:	1447485891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH M CRANDALL MD

Provider Business Mailing Address
First Line	:	8322 BELLONA AVE STE 100
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-2065
Country	:	US
Telephone Number	:	410-337-7900
Fax Number	:	410-769-8591

Provider Business Practice Location Address
First Line	:	7505 OSLER DR STE 104
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7737
Country	:	US
Telephone Number	:	410-337-8888
Fax Number	:	410-823-4833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	07/21/2022

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