Basic Information
| Provider Information | |||||||||
| NPI: | 1093778227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRENSHAW | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | SANDERS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 NORTHLINE AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362737900 | ||||||||
| FaxNumber: | 3362750433 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 NORTHLINE AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362737900 | ||||||||
| FaxNumber: | 3362750433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35619 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 35619 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7963 | 01 | NC | PARTNERS MEDICARE PROVIDE | OTHER | 5175428 | 01 | NC | AETNA PROVIDER NUMBER | OTHER | 1089L | 01 | NC | BCBS NC PROVIDER NUMBER | OTHER | 75907 | 01 | NC | MEDCOST PROVIDER NUMBER | OTHER | 8925647 | 05 | NC | MEDICAID |