Healthcare Provider Details

I. General information

NPI: 1962715896
Provider Name (Legal Business Name): MARY ABIGAIL CRAVEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY-ABIGAIL CRAVEN M.D.

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD SUITE 5000
COLUMBUS OH
43212
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8116
  • Fax: 614-293-4719
Mailing address:
  • Phone: 614-293-8116
  • Fax: 614-293-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35122464
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number35122464
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number35122464
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: