Provider Demographics
NPI:1548282601
Name:STAFFORD, CHARLES CRAIG (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CRAIG
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1451 HARRODSBURG RD
Mailing Address - Street 2:STE D304
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3773
Mailing Address - Country:US
Mailing Address - Phone:859-977-4000
Mailing Address - Fax:859-977-5100
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:BLDG A STE 450
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-373-0215
Practice Address - Fax:859-373-0235
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY24728207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64247281Medicaid
KY7100143740Medicaid
KYCB5773OtherRR MEDICARE GROUP
KY110055370OtherRR MEDICARE PIN
KY4000501OtherMEDICARE LAB GROUP
KY7100144720Medicaid
KY37903705OtherMEDICAID LAB GROUP
KY110055370OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KY7100143740Medicaid