Provider Demographics
NPI:1669489613
Name:WONG, CRAIG (MD MPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:WONG
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Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:MSC10 5590
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6632
Mailing Address - Fax:505-272-6620
Practice Address - Street 1:3RD AMBULATORY CARE CTR
Practice Address - Street 2:2211 LOMAS BLVD. NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3887
Practice Address - Fax:505-272-6620
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-11-06
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Provider Licenses
StateLicense IDTaxonomies
NM2000-3182080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG-79310Medicare UPIN