Provider Demographics
NPI:1750499471
Name:KRYSS, MERI (MD)
Entity type:Individual
Prefix:
First Name:MERI
Middle Name:
Last Name:KRYSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11054 RENNARD ST
Mailing Address - Street 2:UNIT #11054
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:215-698-6980
Mailing Address - Fax:215-698-6981
Practice Address - Street 1:11054 RENNARD ST
Practice Address - Street 2:UNIT #11054
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-698-6980
Practice Address - Fax:215-698-6981
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065819L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01709911Medicaid
G79721Medicare UPIN
016430Medicare ID - Type Unspecified