Provider Demographics
NPI:1902087190
Name:CRANDALL, RICHARD ANDREWS III (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANDREWS
Last Name:CRANDALL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9065
Mailing Address - Country:US
Mailing Address - Phone:717-368-6346
Mailing Address - Fax:
Practice Address - Street 1:1093 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9065
Practice Address - Country:US
Practice Address - Phone:717-368-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420012390207Q00000X
CAG88844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH32001803Medicaid
VT1021110Medicaid
VT1021110Medicaid