Provider Demographics
NPI:1235147638
Name:KRASNY, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:KRASNY
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 1:2336 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2095
Mailing Address - Country:US
Mailing Address - Phone:310-828-7226
Mailing Address - Fax:310-828-4426
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2095
Practice Address - Country:US
Practice Address - Phone:310-828-7226
Practice Address - Fax:310-828-4426
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69870207UN0902X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15185AOtherMEDICARE PTAN - FACILITY
CAG69870OtherMEDICAL LICENSE
CAG69870OtherMEDICAL LICENSE
CAWG69870SMedicare PIN