Provider Demographics
NPI:1699704262
Name:CREIGHTON, MARK G (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:CREIGHTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:182 W MONTAUK HWY
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2345
Mailing Address - Country:US
Mailing Address - Phone:631-723-0223
Mailing Address - Fax:631-723-0323
Practice Address - Street 1:182 W MONTAUK HWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2345
Practice Address - Country:US
Practice Address - Phone:631-723-0223
Practice Address - Fax:631-723-0323
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-08-09
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Provider Licenses
StateLicense IDTaxonomies
NY207383207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG38110Medicare UPIN
NY30X521Medicare ID - Type Unspecified