Provider Demographics
NPI:1891705836
Name:COLLIVER, CRAIG PAUL (MD, FACS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:PAUL
Last Name:COLLIVER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3348
Mailing Address - Country:US
Mailing Address - Phone:301-251-4128
Mailing Address - Fax:301-738-1593
Practice Address - Street 1:9707 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3348
Practice Address - Country:US
Practice Address - Phone:301-251-4128
Practice Address - Fax:301-738-1593
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054429208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD263201200Medicaid
020042800Medicare PIN
G75142Medicare UPIN
004982S97Medicare PIN