Provider Demographics
NPI:1730258294
Name:REZAC, CRAIG (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:REZAC
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 1:1625 N GEORGE MASON DR STE 334
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3690
Mailing Address - Country:US
Mailing Address - Phone:703-717-4180
Mailing Address - Fax:703-717-4181
Practice Address - Street 1:1625 N GEORGE MASON DR STE 334
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3690
Practice Address - Country:US
Practice Address - Phone:703-717-4180
Practice Address - Fax:703-717-4181
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06952500208600000X, 208C00000X
VA0101262770208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069795Medicaid
NJ0069795Medicaid
NJ058891A00Medicare PIN