Provider Demographics
NPI:1376530105
Name:KRAFT, JANE D (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:D
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1229
Mailing Address - Country:US
Mailing Address - Phone:716-592-8931
Mailing Address - Fax:716-592-2152
Practice Address - Street 1:21 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1229
Practice Address - Country:US
Practice Address - Phone:716-592-8931
Practice Address - Fax:716-592-2152
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01478211Medicaid
NY0709713OtherIHA
NY00010094904OtherUNIVERA
NY144659CKOtherPREFERRED CARE
NY040426002785OtherFIDELIS
NY000523272012OtherBC/BS
NY01478211Medicaid
NY144659CKOtherPREFERRED CARE
NYRA5935Medicare PIN