1962828392 NPI number — CHARLES SEAMUS CRANE MASS.MA.60007096

Table of content: CHARLES SEAMUS CRANE MASS.MA.60007096 (NPI 1962828392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962828392 NPI number — CHARLES SEAMUS CRANE MASS.MA.60007096

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANE
Provider First Name:
CHARLES
Provider Middle Name:
SEAMUS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASS.MA.60007096
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962828392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3812 SE DONATO LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98367-7801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-998-7792
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1961 BAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-998-7792
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MASS.MA.60007096 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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