Provider Demographics
NPI:1962715896
Name:CRAVEN, MARY ABIGAIL (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ABIGAIL
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY-ABIGAIL
Other - Middle Name:
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8116
Mailing Address - Fax:614-293-3555
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212
Practice Address - Country:US
Practice Address - Phone:614-293-8116
Practice Address - Fax:614-293-4719
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35122464207W00000X, 207WX0109X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105450Medicaid
OH0105450Medicaid