Provider Demographics
NPI:1144283433
Name:EARLE, CRAIG CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CHRISTOPHER
Last Name:EARLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:156 HILLSDALE AVE E
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ON
Mailing Address - Zip Code:M4S 1T5
Mailing Address - Country:CA
Mailing Address - Phone:647-341-5621
Mailing Address - Fax:416-480-6048
Practice Address - Street 1:2075 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ON
Practice Address - Zip Code:M4N 3M5
Practice Address - Country:CA
Practice Address - Phone:416-480-6047
Practice Address - Fax:416-480-6048
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158916207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189163Medicaid
MA3189163Medicaid