Provider Demographics
NPI:1366525222
Name:KRAMER, MARC STEVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVAN
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:29 PRENTICE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1325
Mailing Address - Country:US
Mailing Address - Phone:617-254-0800
Mailing Address - Fax:617-964-1488
Practice Address - Street 1:17 HENSHAW ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2905
Practice Address - Country:US
Practice Address - Phone:617-254-0800
Practice Address - Fax:617-964-1488
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA397932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0123498Medicaid
MAM09675Medicare UPIN
MAB98719Medicare ID - Type Unspecified