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General NPI Number Information
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NPI Number | 1144269176
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Entity Type | Individual
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Provider Name | COLLEEN MARY CRANDELL D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 PLAZA DR SUITE B
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City | VESTAL
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State | NY
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Zip | 13850-3680
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Country | US
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Telephone | 607-729-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 25 DEBORAH DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-5102
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Country | US
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Telephone | 607-729-0779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 227706
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License Number State | NY
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