Provider Demographics
NPI:1023498854
Name:KRAFT, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MONTGOMERY AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1552
Mailing Address - Country:US
Mailing Address - Phone:610-668-7992
Mailing Address - Fax:610-668-7991
Practice Address - Street 1:915 MONTGOMERY AVE
Practice Address - Street 2:STE 400
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-668-7992
Practice Address - Fax:610-668-7991
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209422207R00000X
PAMD464388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine