Provider Demographics
NPI:1548302243
Name:KRAMER, EDWARD MARK (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARK
Last Name:KRAMER
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 1:3055 W ORANGE AVE
Mailing Address - Street 2:#207
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3159
Mailing Address - Country:US
Mailing Address - Phone:714-229-8246
Mailing Address - Fax:714-229-9362
Practice Address - Street 1:3055 W ORANGE AVE
Practice Address - Street 2:#207
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3159
Practice Address - Country:US
Practice Address - Phone:714-229-8246
Practice Address - Fax:714-229-9362
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57525207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53299Medicare UPIN
CAW15261Medicare ID - Type UnspecifiedGROUP ID#
CAWG57525FMedicare ID - Type UnspecifiedPPIN