Provider Demographics
NPI:1104820687
Name:FOCKLER, CRAIG H (DO)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
Last Name:FOCKLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BLOOMFIELD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3271
Mailing Address - Country:US
Mailing Address - Phone:814-266-5650
Mailing Address - Fax:814-266-5653
Practice Address - Street 1:336 BLOOMFIELD ST STE 201
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3271
Practice Address - Country:US
Practice Address - Phone:814-266-5650
Practice Address - Fax:814-266-5653
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009255L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001600760Medicaid
G41641Medicare UPIN
PA001600760Medicaid