Provider Demographics
NPI:1417908039
Name:KRATZERT, KRISTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:KRATZERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1651
Mailing Address - Country:US
Mailing Address - Phone:315-478-1158
Mailing Address - Fax:315-478-3014
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-478-1158
Practice Address - Fax:315-478-3014
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156147207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01042222Medicaid
NY01042222Medicaid