Provider Demographics
NPI:1285602995
Name:MCCRACKEN, JOSEPH STUART (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STUART
Last Name:MCCRACKEN
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 1:2609 N DUKE ST
Mailing Address - Street 2:#620
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-220-5439
Mailing Address - Fax:919-220-8102
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:#620
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-220-5439
Practice Address - Fax:919-220-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC55903OtherBLUE CROSS
NC8955903Medicaid
NC8955903Medicaid
D62801Medicare UPIN