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General NPI Number Information
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NPI Number | 1467510008
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Entity Type | Organization
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Legal Business Name | MAIN STREET FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 111 VINE ST
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City | HAMMONTON
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State | NJ
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Zip | 08037-1447
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Country | US
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Telephone | 609-561-2518
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Fax |
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Provider Business Mailing Address
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Address Line | 111 VINE ST
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City | HAMMONTON
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State | NJ
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Zip | 08037-1447
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Country | US
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Telephone | 609-561-2518
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. WALTER D CRANE
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Credential | D.O.
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Telephone | 609-561-2518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB42970
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License Number State | NJ
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