Provider Demographics
NPI:1295787141
Name:KRAWITZ, SETH RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:RUSSELL
Last Name:KRAWITZ
Suffix:
Gender:M
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:ELLERBE
Mailing Address - State:NC
Mailing Address - Zip Code:28338-0070
Mailing Address - Country:US
Mailing Address - Phone:206-841-4635
Mailing Address - Fax:
Practice Address - Street 1:400 WESTHAMPTON STA
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3330
Practice Address - Country:US
Practice Address - Phone:206-841-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043996207W00000X
VA0101242140207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01010Medicare PIN