Healthcare Provider Details

I. General information

NPI: 1952386435
Provider Name (Legal Business Name): CRAIG A CHARLESTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 METROPOLITAN DR STE 290
BEAUMONT TX
77706-2409
US

IV. Provider business mailing address

538 BROADWAY
WINNIE TX
77665-7600
US

V. Phone/Fax

Practice location:
  • Phone: 409-554-0545
  • Fax: 409-554-0921
Mailing address:
  • Phone: 409-296-6000
  • Fax: 409-396-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL9653
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberL9653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: