Provider Demographics
NPI:1629017447
Name:KRASNER, DAVID MARC (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARC
Last Name:KRASNER
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 1:1100 S BROOM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4585
Mailing Address - Country:US
Mailing Address - Phone:302-656-5416
Mailing Address - Fax:302-656-5435
Practice Address - Street 1:1100 S BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4585
Practice Address - Country:US
Practice Address - Phone:302-656-5416
Practice Address - Fax:302-656-5435
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20003243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEE14843Medicare UPIN