Provider Demographics
NPI:1376596379
Name:HEINLY, CRAIG STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEPHEN
Last Name:HEINLY
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 1:3008 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6006
Mailing Address - Country:US
Mailing Address - Phone:919-286-7903
Mailing Address - Fax:919-286-7151
Practice Address - Street 1:3008 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6006
Practice Address - Country:US
Practice Address - Phone:919-286-7903
Practice Address - Fax:919-286-7151
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300351207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913375Medicaid
NC13375OtherBLUE CROSS BLUE SHIELD
NC13375OtherBLUE CROSS BLUE SHIELD
NC2017198Medicare ID - Type Unspecified
BH8284250OtherDEA