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NPI Code Detail

MEDICARE: GREGORY JAMES CRADDOCK DO

MEDICARE: GREGORY JAMES CRADDOCK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204D00000XNeuromusculoskeletal Medicine & OMM Physician0102201175VA

General Provider Information

NPI Number : 1912004862
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY JAMES CRADDOCK DO
Provider Business Mailing Address
First Line : 1225 MARTHA CUSTIS DR
Second Line : STE C-7
City : ALEXANDRIA
State : VA
Zip : 22302-2000
Country : US
Telephone Number : 703-998-6760
Fax Number :
Provider Business Practice Location Address
First Line : 1225 MARTHA CUSTIS DR
Second Line : STE C-7
City : ALEXANDRIA
State : VA
Zip : 22302-2000
Country : US
Telephone Number : 703-998-6760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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