Provider Demographics
NPI:1124004627
Name:KRATZER, JOSEPH HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HAROLD
Last Name:KRATZER
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9437
Mailing Address - Fax:704-384-9440
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 309
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-442-3900
Practice Address - Fax:802-442-7208
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA770532084N0400X
SC393872084N0400X
VT042-00082942084N0400X
NC2019029482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGMedicaid
MA3161854Medicaid
VT0VN0034Medicaid
MAJ14995Medicare PIN
MA3161854Medicaid
VT0VN0034Medicaid
SCPENDINGMedicare PIN