Provider Demographics
NPI:1609316173
Name:BRIGHAM, KRAIG III
Entity Type:Individual
Prefix:
First Name:KRAIG
Middle Name:
Last Name:BRIGHAM
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-2151
Mailing Address - Country:US
Mailing Address - Phone:607-624-5985
Mailing Address - Fax:607-724-0081
Practice Address - Street 1:52 MILL ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1967
Practice Address - Country:US
Practice Address - Phone:607-624-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications