Provider Demographics
NPI:1104892769
Name:TRENT, CRAIG CARGILL (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:CARGILL
Last Name:TRENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 BRODHEAD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3101
Mailing Address - Country:US
Mailing Address - Phone:724-728-6284
Mailing Address - Fax:724-728-7416
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-4567
Practice Address - Fax:724-728-9729
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042444L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001468489Medicaid
PA0014684890013Medicaid
PA000000256057OtherUNISON
063479OtherHIGHMARK
PA003479FUDOtherHIGHMARK
PA251343987005OtherTRICARE
PA000000277298OtherUNISON
WV2006037000OtherUNISYS
PA251343987005OtherTRICARE
PA0014684890013Medicaid
PAP00692098Medicare PIN