Provider Demographics
NPI:1346223716
Name:KRATZ, ALEXANDER (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KRATZ
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST PH 1564
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-7399
Mailing Address - Fax:212-342-3013
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:PH3-303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-2654
Practice Address - Fax:212-305-3693
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242125207ZB0001X, 207ZP0105X
MA205990207ZB0001X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0100625Medicaid
MA205990OtherTUFTS HEALTH PLAN
MAJ22429OtherBCBS OF MA
MA205990OtherTUFTS HEALTH PLAN
H15507Medicare UPIN