Provider Demographics
NPI:1952690091
Name:KENNETH E CRAMER MD LLC
Entity Type:Organization
Organization Name:KENNETH E CRAMER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-884-4357
Mailing Address - Street 1:152 W BUTTERCUP RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-1318
Mailing Address - Country:US
Mailing Address - Phone:609-884-4357
Mailing Address - Fax:609-884-4377
Practice Address - Street 1:152 W BUTTERCUP RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-1318
Practice Address - Country:US
Practice Address - Phone:609-884-4357
Practice Address - Fax:609-884-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07528700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041505Medicaid
NJP00314145OtherRAILROAD MEDICARE
NJ0041505Medicaid
NJF87014Medicare UPIN