Provider Demographics
NPI:1609839372
Name:CREASMAN, CRAIG NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:NORMAN
Last Name:CREASMAN
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 1:2400 SAMARITAN DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3910
Mailing Address - Country:US
Mailing Address - Phone:408-369-9300
Mailing Address - Fax:408-369-9599
Practice Address - Street 1:2400 SAMARITAN DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3910
Practice Address - Country:US
Practice Address - Phone:408-369-9300
Practice Address - Fax:408-369-9599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65665208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65665OtherMEDICAL LICENSE
CAE83555Medicare UPIN