1245202852 NPI number — KIRSTA L CRAIG M.D.

Table of content: KIRSTA L CRAIG M.D. (NPI 1245202852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245202852 NPI number — KIRSTA L CRAIG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
KIRSTA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1245202852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22939-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-932-4629
Provider Business Mailing Address Fax Number:
540-932-5875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GREEN HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24482-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-248-4487
Provider Business Practice Location Address Fax Number:
540-248-5312
Provider Enumeration Date:
02/07/2006

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: 207Q00000X , with the licence number:  0101230217 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005604702 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147022 . This is a "SOUTHEN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 700011439 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 42620 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5604702 . This is a "VA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2202916 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 382913 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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