Provider Demographics
NPI:1710911508
Name:WALDEN, CRAIG (MD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:WALDEN
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:PO BOX 931
Mailing Address - Street 2:330 SOUTH MAIN STREET
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-346-8481
Mailing Address - Fax:860-346-8836
Practice Address - Street 1:28 CRESCENT STREET
Practice Address - Street 2:MIDDLESEX HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-344-6293
Practice Address - Fax:860-344-6071
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0297112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000378Medicaid
D88847Medicare UPIN
CT004000378Medicaid