Provider Demographics
NPI:1245383074
Name:DRS KREMEN AND BRESLIN PA
Entity Type:Organization
Organization Name:DRS KREMEN AND BRESLIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KREMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-435-4700
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:POB SUITE 303
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:410-435-4700
Mailing Address - Fax:410-323-0788
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:POB SUITE 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-435-4700
Practice Address - Fax:410-323-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH389Medicare ID - Type Unspecified