Provider Demographics
NPI:1013095496
Name:THOMAS L. CRAIG III M.D. INC
Entity Type:Organization
Organization Name:THOMAS L. CRAIG III M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:216-761-0330
Mailing Address - Street 1:2225 NOBLE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1726
Mailing Address - Country:US
Mailing Address - Phone:216-761-0330
Mailing Address - Fax:
Practice Address - Street 1:2225 NOBLE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112-1726
Practice Address - Country:US
Practice Address - Phone:216-761-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057208173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000496395OtherBLUE CROSS BLUE SHIELD
OH0816915Medicaid
OH0816915Medicaid
OH0649497Medicare PIN