Provider Demographics
NPI:1649488875
Name:KRONSTADT, HERBERT S (DO)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:S
Last Name:KRONSTADT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 WARFIELD LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3323
Mailing Address - Country:US
Mailing Address - Phone:215-947-4477
Mailing Address - Fax:215-947-6655
Practice Address - Street 1:918 WARFIELD LN
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3323
Practice Address - Country:US
Practice Address - Phone:215-947-4477
Practice Address - Fax:215-947-6655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 001964 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34187Medicare UPIN
PAKRO41499Medicare ID - Type Unspecified