Provider Demographics
NPI:1396747713
Name:KRALIOS, CONSTANTINE
Entity type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:KRALIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 PINE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15236-1426
Practice Address - Country:US
Practice Address - Phone:412-650-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419626207V00000X
MA238830207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019162740002Medicaid
WV3810000176Medicaid
MA110082217AMedicaid
OH2558772Medicaid
MA110082217AMedicaid
PA0019162740002Medicaid
OH2558772Medicaid