Healthcare Provider Details

I. General information

NPI: 1053554667
Provider Name (Legal Business Name): BRITTANY CRAIGLOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SHERMAN ST FL 3
FAIRFIELD CT
06824-5849
US

IV. Provider business mailing address

140 SHERMAN ST FL 3
FAIRFIELD CT
06824-5849
US

V. Phone/Fax

Practice location:
  • Phone: 203-538-5682
  • Fax: 203-760-0172
Mailing address:
  • Phone: 203-538-5682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number51925
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number51925
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: