Provider Demographics
NPI:1750351193
Name:CRAFT, NOAH A (MD)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:A
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 PALMS BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3852
Mailing Address - Country:US
Mailing Address - Phone:310-770-5332
Mailing Address - Fax:310-781-9328
Practice Address - Street 1:3640 LOMITA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3956
Practice Address - Country:US
Practice Address - Phone:310-405-0693
Practice Address - Fax:310-356-9126
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76802207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A768020Medicaid
1407474273OtherGROUP NPI FOR GOOD DERM INC
CAWA76802BMedicare PIN
CAI43607Medicare UPIN
CAWA76802AMedicare PIN