Provider Demographics
NPI:1033101431
Name:ANDERSON, CRAIG WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WARREN
Last Name:ANDERSON
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 1:285 E STATE ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4354
Mailing Address - Country:US
Mailing Address - Phone:614-566-9683
Mailing Address - Fax:614-566-8046
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:SUITE 520
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4354
Practice Address - Country:US
Practice Address - Phone:614-566-9683
Practice Address - Fax:614-566-8046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0397012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432606Medicaid
A16030Medicare UPIN