Provider Demographics
NPI:1043732415
Name:CRAIG, CALVIN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:KEITH
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAYSTATE MEDICAL CENTER 759 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-0001
Mailing Address - Country:US
Mailing Address - Phone:413-794-0000
Mailing Address - Fax:
Practice Address - Street 1:1990 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9315
Practice Address - Country:US
Practice Address - Phone:360-856-8800
Practice Address - Fax:360-714-2522
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61343735207R00000X, 207UN0901X, 207RC0000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program