Provider Demographics
NPI:1588764567
Name:KRAVITZ, PAUL HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HOWARD
Last Name:KRAVITZ
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 1:9004 FERN PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-425-5300
Mailing Address - Fax:
Practice Address - Street 1:9004 FERN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-425-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029630207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5976804Medicaid
DC00140001OtherBCBS
0300015OtherUNITED HEALTHCARE
VA0631908OtherANTHEM
VA5976804Medicaid
0300015OtherUNITED HEALTHCARE