Provider Demographics
NPI:1295825206
Name:KRAVITZ, ALAN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:BRUCE
Last Name:KRAVITZ
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 1:11119 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3143
Mailing Address - Country:US
Mailing Address - Phone:301-493-9400
Mailing Address - Fax:301-493-9412
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-493-9400
Practice Address - Fax:301-493-9412
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37295208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD295241600Medicaid
MDC14034OtherRAILROAD GRP#
MD010026389OtherRAILROAD #
MD010026389OtherRAILROAD #
KR530752Medicare ID - Type Unspecified