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General NPI Number Information
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NPI Number | 1043732415
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Entity Type | Individual
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Provider Name | CALVIN KEITH CRAIG MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 1990 HOSPITAL DR STE 100
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-9315
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Country | US
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Telephone | 360-856-8800
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Fax | 360-714-2522
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Provider Business Mailing Address
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Address Line | BAYSTATE MEDICAL CENTER 759 CHESTNUT ST
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City | SPRINGFIELD
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State | MA
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Zip | 01199-0001
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Country | US
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Telephone | 413-794-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD61343735
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | MD61343735
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD61343735
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License Number State | WA
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