Provider Demographics
NPI:1205920626
Name:CRAIG, JULIAN R (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:R
Last Name:CRAIG
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 1:2113 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4227
Mailing Address - Country:US
Mailing Address - Phone:202-563-2844
Mailing Address - Fax:202-563-2337
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:STE 312
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-563-2844
Practice Address - Fax:202-563-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCS9911160174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
491200Medicare PIN
G92367Medicare UPIN
017467C36Medicare ID - Type UnspecifiedMDCR PROV #