Provider Demographics
NPI:1992852040
Name:JONATHAN D KRANT MD MPHPC
Entity Type:Organization
Organization Name:JONATHAN D KRANT MD MPHPC
Other - Org Name:BERKSHIRE RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-445-9117
Mailing Address - Street 1:165 TOR CT
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3001
Mailing Address - Country:US
Mailing Address - Phone:413-445-9117
Mailing Address - Fax:413-445-9449
Practice Address - Street 1:165 TOR CT
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3001
Practice Address - Country:US
Practice Address - Phone:413-445-9117
Practice Address - Fax:413-445-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79140207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9777687Medicaid
MA9777687Medicaid