Provider Demographics
NPI:1447342746
Name:CRENSHAW, RYAN (MD PC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47568 ANCHORAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4712
Mailing Address - Country:US
Mailing Address - Phone:703-421-2875
Mailing Address - Fax:703-421-5701
Practice Address - Street 1:21135 WHITFIELD PL
Practice Address - Street 2:SUITE 102
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7279
Practice Address - Country:US
Practice Address - Phone:703-444-4799
Practice Address - Fax:703-444-4985
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057206207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5858143Medicaid
DC490185Medicare PIN
VA5858143Medicaid
VA100000284Medicare PIN