Provider Demographics
NPI:1740502418
Name:PAUL W. CRAVEN, M.D., INC.
Entity type:Organization
Organization Name:PAUL W. CRAVEN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-734-4090
Mailing Address - Street 1:4859 DOVER CENTER RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3184
Mailing Address - Country:US
Mailing Address - Phone:440-734-4090
Mailing Address - Fax:440-734-2231
Practice Address - Street 1:4859 DOVER CENTER RD
Practice Address - Street 2:SUITE 7
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3184
Practice Address - Country:US
Practice Address - Phone:440-734-4090
Practice Address - Fax:440-734-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046184207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561404Medicaid
OH0562934Medicare PIN
OHC02893Medicare UPIN