Provider Demographics
NPI:1386604783
Name:STUCK, CRAIG ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANDREW
Last Name:STUCK
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:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-5218
Mailing Address - Country:US
Mailing Address - Phone:803-815-5568
Mailing Address - Fax:803-635-4200
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-255-3400
Practice Address - Fax:803-255-3420
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC143762084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC143767Medicaid
SC143767Medicaid
SCH669464411Medicare PIN
H669464411Medicare ID - Type Unspecified