Provider Demographics
NPI:1316950751
Name:KRASNER, JAY BARRY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:BARRY
Last Name:KRASNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BOSTON POST RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776
Mailing Address - Country:US
Mailing Address - Phone:978-443-8010
Mailing Address - Fax:978-443-4634
Practice Address - Street 1:111 BOSTON POST RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776
Practice Address - Country:US
Practice Address - Phone:978-443-8010
Practice Address - Fax:978-443-4634
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ09871OtherMEDICARE ID
MA1316950751OtherNPI
B41679Medicare UPIN