Provider Demographics
NPI:1952386435
Name:CHARLESTON, CRAIG A (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:CHARLESTON
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 1:6025 METROPOLITAN DR STE 290
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2409
Mailing Address - Country:US
Mailing Address - Phone:409-554-0545
Mailing Address - Fax:409-554-0921
Practice Address - Street 1:6025 METROPOLITAN DR STE 290
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2409
Practice Address - Country:US
Practice Address - Phone:409-554-0545
Practice Address - Fax:409-554-0921
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9653207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175366701Medicaid
TX8S9650OtherBLUE CROSS
TX8S9650OtherBLUE CROSS
TX8F1065Medicare PIN