Provider Demographics
NPI:1710985452
Name:THOMAS, CRAIG MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MICHAEL
Last Name:THOMAS
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 1:12200 ANNAPOLIS RD STE 123
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-364-9292
Mailing Address - Fax:855-291-3304
Practice Address - Street 1:12200 ANNAPOLIS RD STE 123
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-364-9292
Practice Address - Fax:855-291-3304
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33852207X00000X
MDD61105207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035938400Medicaid
014295R77Medicare ID - Type Unspecified