Provider Demographics
NPI:1013976950
Name:KRACH, MARIA (RD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KRACH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 MILL POND CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7757
Mailing Address - Country:US
Mailing Address - Phone:260-436-1312
Mailing Address - Fax:260-436-1312
Practice Address - Street 1:2515 MILL POND CT.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-436-1312
Practice Address - Fax:260-436-1312
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000355285OtherANTHEM
IN000000355285OtherANTHEM
IN069860VVVVMedicare PIN
IN058490GGMedicare ID - Type Unspecified
INP55949Medicare UPIN