Provider Demographics
NPI:1336252113
Name:KREFTING, IRA PAUL (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:PAUL
Last Name:KREFTING
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 1:11124 LUXMANOR RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3620
Mailing Address - Country:US
Mailing Address - Phone:301-770-1416
Mailing Address - Fax:301-770-1416
Practice Address - Street 1:11124 LUXMANOR RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3620
Practice Address - Country:US
Practice Address - Phone:301-770-1416
Practice Address - Fax:301-770-1416
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21435207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94621Medicare UPIN
MD409414Medicare ID - Type Unspecified