Provider Demographics
NPI:1699731877
Name:O'DEAR, CRAIG SCOTT (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:SCOTT
Last Name:O'DEAR
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 1:4151 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2531
Mailing Address - Country:US
Mailing Address - Phone:330-492-8001
Mailing Address - Fax:330-492-2080
Practice Address - Street 1:4151 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2531
Practice Address - Country:US
Practice Address - Phone:330-492-8001
Practice Address - Fax:330-492-2080
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075799O207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2121313Medicaid
OH2121313Medicaid
OHG98713Medicare UPIN