Individual
MS. HEIDE KATHLEEN CRANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
46 MARTIN STREET, WELLSVILLE, NY 14895
(585) 593-9497
(585) 596-4048
Mailing address
46 MARTIN STREET, WELLSVILLE, NY 14895
(585) 593-9497
(585) 596-4048
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
210775
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020353001
UNIVERA
NY
01
—
000525220001
BCBS
NY
05
—
01872279
—
NY
Enumeration date
11/08/2005
Last updated
09/28/2022
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