Healthcare Provider Details

I. General information

NPI: 1588776173
Provider Name (Legal Business Name): CRAIG OLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E PUTNAM AVE STE 407
OLD GREENWICH CT
06870-1380
US

IV. Provider business mailing address

1700 E PUTNAM AVE STE 407
OLD GREENWICH CT
06870-1380
US

V. Phone/Fax

Practice location:
  • Phone: 203-242-4520
  • Fax: 203-242-4523
Mailing address:
  • Phone: 203-242-4520
  • Fax: 203-242-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number035158
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: