Provider Demographics
NPI:1184702524
Name:ALLAN S KRATZER MD PC
Entity type:Organization
Organization Name:ALLAN S KRATZER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRATZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-694-8433
Mailing Address - Street 1:435 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2101
Mailing Address - Country:US
Mailing Address - Phone:203-694-8433
Mailing Address - Fax:203-694-7630
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2101
Practice Address - Country:US
Practice Address - Phone:203-694-8433
Practice Address - Fax:203-694-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0297752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00061763OtherMVP SELECT
OV5222OtherHEALTH NET
763823OtherCONNECTICARE
4124913OtherAETNA
CT500HBX153CT01OtherBCBS OF CT
763823OtherCONNECTICARE