Provider Demographics
NPI:1639861826
Name:JENNIE D KRASKER MD LLC
Entity Type:Organization
Organization Name:JENNIE D KRASKER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-683-1183
Mailing Address - Street 1:20 CHAPEL ST APT C307
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-7429
Mailing Address - Country:US
Mailing Address - Phone:617-683-1183
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON ST STE A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3870
Practice Address - Country:US
Practice Address - Phone:617-232-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty