Provider Demographics
NPI:1841420361
Name:CRAVEN, ELIZABETH MUFFETT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MUFFETT
Last Name:CRAVEN
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 1:1553 VALLEY FORGE LANE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6741
Mailing Address - Country:US
Mailing Address - Phone:321-253-9448
Mailing Address - Fax:
Practice Address - Street 1:203 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967
Practice Address - Country:US
Practice Address - Phone:302-537-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0000468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000315301Medicaid
DEF40604Medicare UPIN
DECR431237Medicare PIN