Provider Demographics
NPI:1902839954
Name:KRAG, MARTIN HANS
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:HANS
Last Name:KRAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CROOKED CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7574
Mailing Address - Country:US
Mailing Address - Phone:802-656-4472
Mailing Address - Fax:802-656-4247
Practice Address - Street 1:158 HURRICANE LN
Practice Address - Street 2:SPINE INSTITUTE OF NEW ENGLAND/FAHC
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-847-9005
Practice Address - Fax:802-847-6278
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006594207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00719902Medicaid
VT0005260Medicaid
NY00719902Medicaid
D03235Medicare UPIN