Provider Demographics
NPI:1609844398
Name:KOENIG, CRAIG S (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:KOENIG
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 1:300 MEDICAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-547-7702
Mailing Address - Fax:757-548-2725
Practice Address - Street 1:300 MEDICAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-547-7702
Practice Address - Fax:757-548-2725
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116016274207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF1969OtherRAILROAD MEDICARE GROUP #
VA010288835Medicaid
VAC01592OtherMEDICARE GROUP #
1326022880OtherGROUP NPI#
1609844398OtherINDIVIDUAL NPI#
1609844398OtherINDIVIDUAL NPI#
H95383Medicare UPIN
VAC01592OtherMEDICARE GROUP #