Provider Demographics
NPI:1568737732
Name:KRATOCHVIL, ALYSSA RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:RAE
Last Name:KRATOCHVIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HANOVER ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5451
Mailing Address - Country:US
Mailing Address - Phone:508-679-7770
Mailing Address - Fax:
Practice Address - Street 1:300 HANOVER ST
Practice Address - Street 2:STE 1E
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5451
Practice Address - Country:US
Practice Address - Phone:508-679-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265495207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400305030OtherPTAN