1144283433 NPI number — DR. CRAIG CHRISTOPHER EARLE MD

Table of content: DR. CRAIG CHRISTOPHER EARLE MD (NPI 1144283433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144283433 NPI number — DR. CRAIG CHRISTOPHER EARLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EARLE
Provider First Name:
CRAIG
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144283433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
156 HILLSDALE AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORONTO
Provider Business Mailing Address State Name:
ON
Provider Business Mailing Address Postal Code:
M4S 1T5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
647-341-5621
Provider Business Mailing Address Fax Number:
416-480-6048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2075 BAYVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORONTO
Provider Business Practice Location Address State Name:
ON
Provider Business Practice Location Address Postal Code:
M4N 3M5
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
416-480-6047
Provider Business Practice Location Address Fax Number:
416-480-6048
Provider Enumeration Date:
04/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  158916 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3189163 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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