Healthcare Provider Details

I. General information

NPI: 1447638952
Provider Name (Legal Business Name): CHRISTOPHER CHARLES CRANSTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST PHIPPS 174
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST PHIPPS 174
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-2438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number05686
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: