Provider Demographics
NPI:1740806678
Name:BLANKENDAAL-KRAMER, DYLAN RAE (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:RAE
Last Name:BLANKENDAAL-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 1:3600 FORBES AVENUE
Mailing Address - Street 2:FORBES TOWER - PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 W COVELL BLVD STE AB&C
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5671
Practice Address - Country:US
Practice Address - Phone:530-747-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHS000288L390200000X
CA187576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program