Healthcare Provider Details

I. General information

NPI: 1053358887
Provider Name (Legal Business Name): CRAIG T HAYTMANEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/24/2024
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DELAWARE AVE
FOUNTAIN HILL PA
18015-1171
US

IV. Provider business mailing address

735 DELAWARE AVE
FOUNTAIN HILL PA
18015-1171
US

V. Phone/Fax

Practice location:
  • Phone: 610-419-4494
  • Fax: 610-419-4740
Mailing address:
  • Phone: 610-419-4494
  • Fax: 610-419-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD020500E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD020500E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD020500E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD020500E
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD020500E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: