Provider Demographics
NPI:1598739922
Name:KRAFTY, MARY BETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:KRAFTY
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 1:111 TONY ROW
Mailing Address - Street 2:PO BOX 337
Mailing Address - City:STAR JUNCTION
Mailing Address - State:PA
Mailing Address - Zip Code:15482-0337
Mailing Address - Country:US
Mailing Address - Phone:724-736-0601
Mailing Address - Fax:724-736-0940
Practice Address - Street 1:111 TONY ROW
Practice Address - Street 2:
Practice Address - City:STAR JUNCTION
Practice Address - State:PA
Practice Address - Zip Code:15482
Practice Address - Country:US
Practice Address - Phone:724-736-0601
Practice Address - Fax:724-736-0940
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029900E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1134170Medicaid
PA414424Medicare ID - Type Unspecified
PA1134170Medicaid