# CRAIG M FETTERMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1902868383
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 230757 | NY | — |
| 208M00000X | Hospitalist Physician | 230757-1 | NY | Yes |

## Other

- **Enumeration date:** 04/03/2006
- **Last updated:** 08/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000527760001 | BC/BS | NY |
| 01 | — | 0026827302 | UNIVERA | NY |
| 05 | — | 02533062 | — | NY |
| 01 | — | 041006000116 | FIDELIS | NY |
| 01 | — | 0412489 | INDEPENDENT HEALTH | NY |