Provider Demographics
NPI:1326075615
Name:CRAIGEN, RHEA (MD)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:CRAIGEN
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 1:7955 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3243
Mailing Address - Country:US
Mailing Address - Phone:708-267-3926
Mailing Address - Fax:
Practice Address - Street 1:3721 SAINT JOHNS LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5226
Practice Address - Country:US
Practice Address - Phone:708-267-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089950207Q00000X
MDD0077321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00418918OtherRAILROAD MEDICARE
IL1634566OtherBCBS PROVIDER ID
IL036089950Medicaid
IL036089950Medicaid
ILK11862Medicare PIN
ILP00418918OtherRAILROAD MEDICARE