Provider Demographics
NPI:1639257058
Name:KRATZER, ALLAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:S
Last Name:KRATZER
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 1:435 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2101
Mailing Address - Country:US
Mailing Address - Phone:203-694-8433
Mailing Address - Fax:203-694-7630
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2101
Practice Address - Country:US
Practice Address - Phone:203-694-8433
Practice Address - Fax:203-694-7630
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0297752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4124913OtherAETNA
763823OtherCONNECTICARE
OV5222OtherHEALTH NET
500HBX153CT01OtherBCBS OF CT
P00061763OtherMVP SELECT