Healthcare Provider Details

I. General information

NPI: 1124197470
Provider Name (Legal Business Name): CRAIG ALAN MAXWELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HAMILTON-CLEVES ROAD SUITE 5
HAMILTON OH
45013-8952
US

IV. Provider business mailing address

4421 HAMILTON-CLEVES ROAD SUITE 5
HAMILTON OH
45013-8952
US

V. Phone/Fax

Practice location:
  • Phone: 513-741-4404
  • Fax: 513-741-7994
Mailing address:
  • Phone: 513-741-4404
  • Fax: 513-741-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34003560M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: