Provider Demographics
NPI:1447485891
Name:CRANDALL, KENNETH M (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8322 BELLONA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2065
Mailing Address - Country:US
Mailing Address - Phone:410-337-7900
Mailing Address - Fax:410-769-8591
Practice Address - Street 1:7505 OSLER DR STE 104
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7737
Practice Address - Country:US
Practice Address - Phone:410-337-8888
Practice Address - Fax:410-823-4833
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MDD0083337207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0083337OtherMARYLAND LICENSE