Provider Demographics
NPI:1245202852
Name:CRAIG, KIRSTA L (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTA
Middle Name:L
Last Name:CRAIG
Suffix:
Gender:F
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:1 GREEN HILL DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2654
Practice Address - Country:US
Practice Address - Phone:540-248-4487
Practice Address - Fax:540-248-5312
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005604702Medicaid
VA147022OtherSOUTHEN HEALTH
VA700011439OtherCIGNA
VA42620OtherSENTARA
VA5604702OtherVA PREMIER
VA2202916OtherFIRST HEALTH
VA382913OtherANTHEM
VA080007641Medicare ID - Type Unspecified
VAC06248Medicare PIN
VA147022OtherSOUTHEN HEALTH
VA2202916OtherFIRST HEALTH
VA42620OtherSENTARA