Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 33692 | MA |
NPI | 1174524078 |
---|---|
Provider Name | Dr. Gail K Kraft |
First Address | Weston, MA 02493-1455 |
Second Address | Weston, MA 02493-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2066114 | (05) | MA |
B51046 | BLUE CROSS / BLUE SHIELD (01) | MA |
D88149 | (02) | MA |