Provider Demographics
NPI:1417947243
Name:KRAFT, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
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 1:908 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2533
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:BAYSTATE MEDICAL CTR
Practice Address - Street 2:759 CHESTNUT ST
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0001
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39685207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02400OtherBCBS MA
MA6168604Medicaid
MA039685OtherTUFTS HEALTH PLAN
B96395Medicare UPIN
MA6168604Medicaid