Provider Demographics
NPI:1306994439
Name:KRASNER, PAUL R (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:KRASNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COMMONWEALTH CT STE H
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4437
Mailing Address - Country:US
Mailing Address - Phone:919-467-2876
Mailing Address - Fax:919-467-2928
Practice Address - Street 1:102 COMMONWEALTH CT
Practice Address - Street 2:STE H
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4400
Practice Address - Country:US
Practice Address - Phone:919-467-2876
Practice Address - Fax:919-467-2928
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC751103G00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04057OtherBLUECROSS PROVIDER NUMBER
NC0267GOtherBLUECROSS GROUP PROVIDER