Provider Demographics
NPI:1790529022
Name:CRAIG, DE'MARKO
Entity type:Individual
Prefix:
First Name:DE'MARKO
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MATHEWS RD APT 3
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3030
Mailing Address - Country:US
Mailing Address - Phone:419-389-2127
Mailing Address - Fax:
Practice Address - Street 1:440 MATHEWS RD APT 3
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-3030
Practice Address - Country:US
Practice Address - Phone:419-389-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator