Healthcare Provider Details

I. General information

NPI: 1972501690
Provider Name (Legal Business Name): CRAIG ANTHONY VITRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6757 BURDEN LN
BATON ROUGE LA
70808-4212
US

IV. Provider business mailing address

6757 BURDEN LN
BATON ROUGE LA
70808-4212
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0940
  • Fax: 225-819-0069
Mailing address:
  • Phone: 225-767-0940
  • Fax: 225-819-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number015097
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: