Provider Demographics
NPI:1659351757
Name:KRAVITZ, ELAINE KAREN (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:KAREN
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6474
Mailing Address - Country:US
Mailing Address - Phone:609-458-0931
Mailing Address - Fax:
Practice Address - Street 1:2519 PANAMA ST STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6474
Practice Address - Country:US
Practice Address - Phone:609-458-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024988E207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
43859Medicare ID - Type Unspecified
B96736Medicare UPIN