Provider Demographics
NPI:1891894531
Name:KRANSON, BLAIR S (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:S
Last Name:KRANSON
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 1:7320 WOODLAKE AVE STE 395
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1496
Mailing Address - Country:US
Mailing Address - Phone:818-347-0681
Mailing Address - Fax:818-347-0955
Practice Address - Street 1:7320 WOODLAKE AVE STE 395
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1496
Practice Address - Country:US
Practice Address - Phone:818-347-0681
Practice Address - Fax:818-347-0955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40294207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40294Medicare ID - Type Unspecified
CAA48177Medicare UPIN
CADM104ZMedicare PIN