Provider Demographics
NPI:1588618169
Name:KRAMER, JEFFREY RAE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RAE
Last Name:KRAMER
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 1:873 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488
Mailing Address - Country:US
Mailing Address - Phone:843-542-9535
Mailing Address - Fax:843-542-9675
Practice Address - Street 1:873 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488
Practice Address - Country:US
Practice Address - Phone:843-542-9535
Practice Address - Fax:843-542-9675
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC184268Medicaid
SCG64928Medicare UPIN
SCG649280281Medicare ID - Type Unspecified
SC184268Medicaid