Provider Demographics
NPI:1275583510
Name:KRATZER, GLENN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:S
Last Name:KRATZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:798 HAUSMAN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9108
Practice Address - Country:US
Practice Address - Phone:610-530-2290
Practice Address - Fax:484-403-4007
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016577E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000715638002Medicaid
PA110118146OtherPALMETTO RR
PA079365OtherHIGHMARK BLUE SHIELD
PA01054203OtherCAPITAL BLUE CROSS
PA000715638002Medicaid
PA079365H9MMedicare PIN
PA079365OtherHIGHMARK BLUE SHIELD