Provider Demographics
NPI:1790740934
Name:CRANMER, KEVIN BURKE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BURKE
Last Name:CRANMER
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 1:12 CASE ST STE 215
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-373-4148
Mailing Address - Fax:860-908-2353
Practice Address - Street 1:12 CASE ST STE 215
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-373-4148
Practice Address - Fax:860-908-2353
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044355207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001443556Medicaid
CTP00734658OtherMEDICARE RAILROAD
CT044355OtherCONNECTICARE
CT2679264OtherUNITED HEALTHCARE
CT3V1443OtherHEALTHNET
CT3V1443OtherHEALTHNET
CT001443556Medicaid
CT180001056Medicare PIN