Provider Demographics
NPI:1366833840
Name:ELDRIDGE, CRAIG M (PA-C)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3465
Mailing Address - Country:US
Mailing Address - Phone:508-539-2444
Mailing Address - Fax:508-539-2445
Practice Address - Street 1:5 INDUSTRIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3465
Practice Address - Country:US
Practice Address - Phone:508-539-2444
Practice Address - Fax:508-539-2445
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100149322Medicaid