Provider Demographics
NPI:1891730180
Name:EHRENKRANZ, PETER DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DOUGLAS
Last Name:EHRENKRANZ
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:PO BOX 8500-2161
Mailing Address - Street 2:LAWN AVENUE MEDICAL ASSOCIATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:610-668-6491
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:700 LAWN AVE
Practice Address - Street 2:GRAND VIEW HOSPITAL
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1548
Practice Address - Country:US
Practice Address - Phone:215-453-4139
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098573Medicare ID - Type Unspecified
I49656Medicare UPIN