Provider Demographics
NPI:1487706693
Name:CRANCE, MATTHEW TYLER (PAC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TYLER
Last Name:CRANCE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:42 LAMBERT ST
Mailing Address - Street 2:STE 111
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2421
Mailing Address - Country:US
Mailing Address - Phone:540-461-3395
Mailing Address - Fax:
Practice Address - Street 1:108 HOUSTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450
Practice Address - Country:US
Practice Address - Phone:540-463-3162
Practice Address - Fax:540-463-3213
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA011002239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant