Provider Demographics
NPI:1407830086
Name:KRAMER, LARRY SAUL (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:SAUL
Last Name:KRAMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-602-8500
Mailing Address - Fax:215-676-6507
Practice Address - Street 1:9331 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-4634
Practice Address - Country:US
Practice Address - Phone:215-602-8500
Practice Address - Fax:215-676-6507
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL053167207Q00000X
NJ25MB02319500207Q00000X
PAOS-002606-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3713905OtherAETNA HMO
PA000650918Medicaid
PA0057927000OtherINDEPENDENCE BLUE CROSS
PA1094821OtherCIGNA
PA4102303OtherAETNA PPO
PA0065091803OtherAMERICHOICE
PA041820OtherHIGHMARK BLUE SHIELD
PA30016926OtherKEYSTONE MERCY HEALTH
PA544680OtherCOVENTRY HEALTH AMERICA
PA3Y6946OtherHEALTH NET
PA5576OtherBRAVO HEALTH
PAP0044625OtherRAILROAD MEDICARE
PA000650918Medicaid
PA544680OtherCOVENTRY HEALTH AMERICA