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General NPI Number Information
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NPI Number | 1821079724
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Entity Type | Individual
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Provider Name | PHILIP B. KRAFT M. D.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 800 BROADWAY
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City | CHELSEA
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State | MA
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Zip | 02150-3016
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Country | US
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Telephone | 617-884-8840
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Fax | 617-884-7755
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Provider Business Mailing Address
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Address Line | 50 DELANO AVE
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City | REVERE
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State | MA
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Zip | 02151-1727
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Country | US
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Telephone | 617-884-8840
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Fax | 617-884-7755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41242
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License Number State | MA
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