Provider Demographics
NPI:1790870137
Name:CRAIG, ANN W (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:W
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-329-0204
Mailing Address - Fax:606-324-7770
Practice Address - Street 1:700 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-329-0204
Practice Address - Fax:606-324-7770
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30254208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65917544OtherGROUP KY MEDICAID ID
WV0110240000Medicaid
KY000000062597OtherANTHEM BC
OH25721579Medicaid
KY336109752062213OtherBC SUPER BLUE PLUS
KY6109752062213OtherBC PPO
KY64302540Medicaid
KY12-03043OtherUNITED HEALTH CARE