Healthcare Provider Details

I. General information

NPI: 1902880909
Provider Name (Legal Business Name): CRAIG CARPENTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 OLENTANGY RIVER RD
COLUMBUS OH
43212-3135
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4710
  • Fax: 614-566-6846
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35084635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: