Provider Demographics
NPI:1386609782
Name:FROEDE, CRAIG B (MD FACP)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:FROEDE
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NMCCL WOUNDED WARRIOR CLINIC NW128
Mailing Address - Street 2:100 BREWSTER BLVD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-450-9812
Mailing Address - Fax:910-450-3345
Practice Address - Street 1:100 BREWSTER BLVD # NW128
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-450-3812
Practice Address - Fax:910-450-3345
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD95321Medicare UPIN
VA004185P95 - C03895Medicare PIN