Provider Demographics
NPI:1992149686
Name:CRAIG R. DUFRESNE, M.D., P.C.
Entity type:Organization
Organization Name:CRAIG R. DUFRESNE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUFRESNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-207-3065
Mailing Address - Street 1:8501 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4617
Mailing Address - Country:US
Mailing Address - Phone:703-207-3065
Mailing Address - Fax:
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-207-3065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
166727OtherMEDICARE PTEN
B70265Medicare UPIN