Provider Demographics
NPI:1194135640
Name:FRONTLINE MEDICAL & KIDNEY CARE, LLC
Entity type:Organization
Organization Name:FRONTLINE MEDICAL & KIDNEY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-973-3391
Mailing Address - Street 1:451 CHEW ST STE 407
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3424
Mailing Address - Country:US
Mailing Address - Phone:610-973-3391
Mailing Address - Fax:610-973-3395
Practice Address - Street 1:451 CHEW ST STE 407
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3424
Practice Address - Country:US
Practice Address - Phone:610-973-3391
Practice Address - Fax:610-973-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
PAMD439884207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty