Provider Demographics
NPI:1124197470
Name:MAXWELL, CRAIG ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:MAXWELL
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 1:4421 HAMILTON-CLEVES ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8952
Mailing Address - Country:US
Mailing Address - Phone:513-741-4404
Mailing Address - Fax:513-741-7994
Practice Address - Street 1:4421 HAMILTON-CLEVES ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8952
Practice Address - Country:US
Practice Address - Phone:513-741-4404
Practice Address - Fax:513-741-7994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003560M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14200OtherANTHEM
OH03560OtherHUMANA
OHP00471069OtherRR MEDICARE
OH0543273Medicaid
A15461Medicare UPIN
OH0534702Medicare PIN