Provider Demographics
NPI:1952351041
Name:HYATT, MARK CRAYCROFT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CRAYCROFT
Last Name:HYATT
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 1:130 SOUTHERN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3223
Mailing Address - Country:US
Mailing Address - Phone:606-679-4782
Mailing Address - Fax:
Practice Address - Street 1:200 E FRAZIER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1915
Practice Address - Country:US
Practice Address - Phone:270-384-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0501217Medicare PIN
KY0500026Medicare PIN
KY0500706Medicare PIN
KYC65994Medicare UPIN
KY0500415Medicare PIN
KY0500521Medicare PIN
KY0500916Medicare PIN
KY0501015Medicare PIN
KY0577202Medicare PIN
KY0500224Medicare PIN
KY0500621Medicare PIN
KY0512907Medicare PIN
KY0500312Medicare PIN