Provider Demographics
NPI:1831576412
Name:CRAFT, DEVON MARK (DO)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:MARK
Last Name:CRAFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-1017
Mailing Address - Country:US
Mailing Address - Phone:845-272-1035
Mailing Address - Fax:845-272-1029
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1017
Practice Address - Country:US
Practice Address - Phone:845-272-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY292692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program