Provider Demographics
NPI:1154301844
Name:SELF, CRAIG S (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:SELF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-873-6517
Practice Address - Street 1:646 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3423
Practice Address - Country:US
Practice Address - Phone:704-872-4108
Practice Address - Fax:704-873-6517
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37314-020207W00000X
NC2006-01037207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000293958OtherUNISON HEALTH PLAN SC
NC1447COtherBCBS NC
NC5906409Medicaid
SC81899OtherCHC CARES OF SC
SCP00421356OtherRAILROAD MEDICARE
SCQ37006Medicaid
NC7405845OtherAETNA
NC199111OtherMEDCOST
SC20096155OtherSELECT HEALTH OF SC
NC2687OtherEVOLUTIONS
SC01152096OtherAMERIGROUP COMMUNITY CARE
SC81899OtherCHC CARES OF SC
NC0264730001Medicare NSC