Healthcare Provider Details

I. General information

NPI: 1417952953
Provider Name (Legal Business Name): CRAIG S ZYLKA CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 NORTH AVE STE 101
BEL AIR MD
21014-2303
US

IV. Provider business mailing address

615 W MACPHAIL RD STE 106
BEL AIR MD
21014-4393
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-6434
  • Fax:
Mailing address:
  • Phone: 410-638-8900
  • Fax: 410-638-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR129525
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: