Provider Demographics
NPI:1962502484
Name:KRAFT, SUSAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:KRAFT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:328 SHREWSBURY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4613
Mailing Address - Country:US
Mailing Address - Phone:508-755-4861
Mailing Address - Fax:508-752-1392
Practice Address - Street 1:328 SHREWSBURY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4613
Practice Address - Country:US
Practice Address - Phone:508-755-4861
Practice Address - Fax:508-752-1392
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2017-03-16
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Provider Licenses
StateLicense IDTaxonomies
MA58583207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3089576Medicaid
MAS400127044Medicare PIN
MAB76972Medicare UPIN
MAS400127044Medicare PIN