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NPI Code Detail

MEDICARE: DR. DEVON MARK CRAFT DO

MEDICARE:  DR. DEVON MARK CRAFT  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician292692NY

General Provider Information

NPI Number : 1831576412
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEVON MARK CRAFT DO
Provider Business Mailing Address
First Line : 38 N MAIN ST
Second Line :
City : ELLENVILLE
State : NY
Zip : 12428-1017
Country : US
Telephone Number : 845-272-1035
Fax Number : 845-272-1029
Provider Business Practice Location Address
First Line : 38 N MAIN ST
Second Line :
City : ELLENVILLE
State : NY
Zip : 12428-1017
Country : US
Telephone Number : 845-272-1035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2015
Last Update Date : 04/04/2019

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