Provider Demographics
NPI:1194266114
Name:MCCRADY, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MCCRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 KING RUSSELL CT
Mailing Address - Street 2:
Mailing Address - City:MCGAHEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22840-2694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9220 KING RUSSELL CT
Practice Address - Street 2:
Practice Address - City:MCGAHEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22840-2694
Practice Address - Country:US
Practice Address - Phone:540-383-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAI080779002146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate