Provider Demographics
NPI:1134133028
Name:EDMONDS, CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:EDMONDS
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 1:825 FIFTH AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHOMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4214
Mailing Address - Country:US
Mailing Address - Phone:717-262-9700
Mailing Address - Fax:717-262-9714
Practice Address - Street 1:1150 PROFESSIONAL COURT
Practice Address - Street 2:SUITE B
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-797-8788
Practice Address - Fax:301-797-2218
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD967711900Medicaid
C57417Medicare UPIN
2992Medicare ID - Type Unspecified