Provider Demographics
NPI:1316929193
Name:EMBLIDGE, CRAIG ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:EMBLIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 IRONGATE CENTER
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3471
Mailing Address - Country:US
Mailing Address - Phone:518-793-4409
Mailing Address - Fax:518-793-5886
Practice Address - Street 1:3 IRONGATE CENTER
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3471
Practice Address - Country:US
Practice Address - Phone:518-793-4409
Practice Address - Fax:518-793-5886
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY131760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000401107001OtherBLUE SHIELD WNY
NY5155216OtherAETNA
NY021200700170OtherFIDELIS
CD1981OtherRAILROAD MEDICARE GROUP #
NY00020626501OtherUNIVERA
NY000401107001OtherBLUE SHIELD NENY
NY10502264OtherCAQH
NY0022159OtherGHI
NY00417565Medicaid
NY10000575OtherCDPHP
NY08170OtherMVP
NY28D701OtherBLUE CROSS BLUE SHIELD
NYNY0023466OtherTRICARE
NY000000053973OtherGHI-HMO
NY28D701OtherBLUE CROSS BLUE SHIELD
NYB81732Medicare UPIN