Provider Demographics
NPI:1225132269
Name:KRAVITZ, KERRY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:DEAN
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:905 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6622
Mailing Address - Country:US
Mailing Address - Phone:650-854-7076
Mailing Address - Fax:650-233-9658
Practice Address - Street 1:4370 ALPINE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7952
Practice Address - Country:US
Practice Address - Phone:650-529-2333
Practice Address - Fax:650-529-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0482602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50983Medicare UPIN
CA00G482600Medicare ID - Type Unspecified