Provider Demographics
NPI:1851395693
Name:CRAIG, JENNIFER MAE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MAE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MAE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1465 N GARDNER ST
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7751
Mailing Address - Country:US
Mailing Address - Phone:812-752-0001
Mailing Address - Fax:812-752-0010
Practice Address - Street 1:1465 N. GARDNER STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170
Practice Address - Country:US
Practice Address - Phone:812-752-0001
Practice Address - Fax:812-752-0010
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054398A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200330610AMedicaid
000000370661OtherIN KY ANTHEM BCBS
IN230180Medicare ID - Type Unspecified
INH-44889Medicare UPIN