1487768537 NPI number — MS. CAROLINE MARGARET CRAIG MSPT

Table of content: MS. CAROLINE MARGARET CRAIG MSPT (NPI 1487768537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487768537 NPI number — MS. CAROLINE MARGARET CRAIG MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
CAROLINE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1487768537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 913
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILDER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-296-7778
Provider Business Mailing Address Fax Number:
802-296-7773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2458 CHRISTIAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE RIVER JCT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-296-7778
Provider Business Practice Location Address Fax Number:
802-296-7773
Provider Enumeration Date:
08/18/2006

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: 225100000X , with the licence number:  0400072387 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 2540 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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