Provider Demographics
NPI:1528053048
Name:CRAIG-BUCKHOLTZ, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:CRAIG-BUCKHOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2211 ERIN WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6360
Mailing Address - Country:US
Mailing Address - Phone:410-776-2259
Mailing Address - Fax:
Practice Address - Street 1:3718 NORRISVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1419
Practice Address - Country:US
Practice Address - Phone:410-692-5292
Practice Address - Fax:410-557-4256
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD466771900Medicaid
MD891L284EMedicare PIN
MD466771900Medicaid