Provider Demographics
NPI:1972525392
Name:DUFRESNE, CRAIG R (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:DUFRESNE
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
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Mailing Address - Street 1:8501 ARLINGTON BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4625
Mailing Address - Country:US
Mailing Address - Phone:703-207-3065
Mailing Address - Fax:703-207-2002
Practice Address - Street 1:8501 ARLINGTON BLVD STE 420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4625
Practice Address - Country:US
Practice Address - Phone:703-207-3065
Practice Address - Fax:703-207-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52-2003266174400000X
DCMD179382086S0122X
MDD00322662086S0122X
VA01010438172086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist