Provider Demographics
NPI:1962416032
Name:KRAHNERT, JOHN FREDERICK JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:KRAHNERT
Suffix:JR
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:PO BOX 843257
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3257
Mailing Address - Country:US
Mailing Address - Phone:910-715-4111
Mailing Address - Fax:910-715-4101
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-4111
Practice Address - Fax:910-715-4101
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-39002208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
50261OtherBCBS OF NC
NC8950261Medicaid
NCFH2000235OtherFIRSTCAROLINA CARE
SCN39002Medicaid
50261OtherBCBS OF NC
NCC72555Medicare UPIN
NCFH2000235OtherFIRSTCAROLINA CARE
NC8950261Medicaid