Provider Demographics
NPI:1023165172
Name:KRANT, JONATHAN D (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:KRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:458 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1201
Mailing Address - Country:US
Mailing Address - Phone:603-924-2640
Mailing Address - Fax:855-576-4763
Practice Address - Street 1:458 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1201
Practice Address - Country:US
Practice Address - Phone:603-924-2640
Practice Address - Fax:855-576-4763
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272171207RR0500X
OH35.134834207RR0500X
NH25530207RR0500X
MA79140207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0317272Medicaid
NY03768123Medicaid
MAJ13940Medicare ID - Type Unspecified
NY03768123Medicaid