Healthcare Provider Details

I. General information

NPI: 1013974039
Provider Name (Legal Business Name): CRAIG DOUGLAS CALDWELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 ROUTE 19 N STE B
WATERFORD PA
16441-9739
US

IV. Provider business mailing address

991 ROUTE 19 N STE B
WATERFORD PA
16441-9739
US

V. Phone/Fax

Practice location:
  • Phone: 814-796-2553
  • Fax: 814-796-4238
Mailing address:
  • Phone: 814-796-2553
  • Fax: 814-796-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016268
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004678L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: