Provider Demographics
NPI:1821079724
Name:KRAFT, PHILIP B (M D)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:B
Last Name:KRAFT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DELANO AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1727
Mailing Address - Country:US
Mailing Address - Phone:617-884-8840
Mailing Address - Fax:617-884-7755
Practice Address - Street 1:800 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3016
Practice Address - Country:US
Practice Address - Phone:617-884-8840
Practice Address - Fax:617-884-7755
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA412422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry