Provider Demographics
NPI:1699764837
Name:CRITCHLEY, CRAIG (DO)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:CRITCHLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S STANFIELD RD
Mailing Address - Street 2:STE. A
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2372
Mailing Address - Country:US
Mailing Address - Phone:937-339-5355
Mailing Address - Fax:937-339-3056
Practice Address - Street 1:700 S STANFIELD RD
Practice Address - Street 2:STE. A
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2372
Practice Address - Country:US
Practice Address - Phone:937-339-5355
Practice Address - Fax:937-339-3056
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002866C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473483Medicaid
OH0473483Medicaid
OHH480630Medicare PIN