Provider Demographics
NPI:1023331014
Name:BLUE, CRAIG A (CO)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:BLUE
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6416
Mailing Address - Country:US
Mailing Address - Phone:740-692-4911
Mailing Address - Fax:740-375-6428
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7000
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLO.10222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2281534Medicaid