Provider Demographics
NPI:1194701821
Name:FOX, CRAIG DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DOUGLAS
Last Name:FOX
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 1:2 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3335
Mailing Address - Country:US
Mailing Address - Phone:724-228-4550
Mailing Address - Fax:724-228-3746
Practice Address - Street 1:2 WILSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3335
Practice Address - Country:US
Practice Address - Phone:724-228-4550
Practice Address - Fax:724-228-3746
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025638E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017701100OtherBLACK LUNG
PA000898547Medicaid
PA080008703OtherRAILROAD MEDICARE 193391
PAC33217Medicare UPIN
PA017701100OtherBLACK LUNG