Provider Demographics
NPI:1013916493
Name:REIMER, CRAIG L (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:REIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2930
Mailing Address - Country:US
Mailing Address - Phone:570-622-2341
Mailing Address - Fax:570-622-1132
Practice Address - Street 1:407 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2930
Practice Address - Country:US
Practice Address - Phone:570-622-2341
Practice Address - Fax:570-622-1132
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030455E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010138270001Medicaid
PA02531300OtherCAPITOL BC
PA02531300OtherCAPITOL BC
PA098905Medicare PIN