Provider Demographics
NPI:1073142071
Name:GOLDHAGEN, CRAIG ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ROBERT
Last Name:GOLDHAGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 LONG RUN RD
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2075
Mailing Address - Country:US
Mailing Address - Phone:210-857-7339
Mailing Address - Fax:
Practice Address - Street 1:221 LONG RUN RD
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-2075
Practice Address - Country:US
Practice Address - Phone:210-857-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOT020331208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program