Healthcare Provider Details

I. General information

NPI: 1891876710
Provider Name (Legal Business Name): CHARLES T. CRINNIAN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST SUITE 304
SCOTTSDALE AZ
85258-4510
US

IV. Provider business mailing address

10250 N 92ND ST SUITE 304
SCOTTSDALE AZ
85258-4510
US

V. Phone/Fax

Practice location:
  • Phone: 480-451-7676
  • Fax: 480-451-0971
Mailing address:
  • Phone: 480-451-7676
  • Fax: 480-451-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number21041
License Number StateAZ

VIII. Authorized Official

Name: DR. CHARLES THOMAS CRINNIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 480-451-7676