Provider Demographics
NPI:1649264607
Name:ORAL AND FACIAL SURGERY DRS. KRAMER AND KOTEREWAS, PA
Entity type:Organization
Organization Name:ORAL AND FACIAL SURGERY DRS. KRAMER AND KOTEREWAS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-791-1700
Mailing Address - Street 1:19414-B LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-7601
Mailing Address - Country:US
Mailing Address - Phone:301-791-1700
Mailing Address - Fax:301-791-9257
Practice Address - Street 1:19414-B LEITERSBURG PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-7601
Practice Address - Country:US
Practice Address - Phone:301-791-1700
Practice Address - Fax:301-791-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
056LMedicare UPIN
O56LMedicare UPIN
MD056LMedicare ID - Type Unspecified