MEDICARE: LARRY SAUL KRAMER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	053167	FL
2	207Q00000X	Family Medicine Physician	25MB02319500	NJ
3	207Q00000X	Family Medicine Physician	OS-002606-L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	P0044625	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3713905	OTHER	PA	AETNA HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0057927000	OTHER	PA	INDEPENDENCE BLUE CROSS
4	1094821	OTHER	PA	CIGNA
5	4102303	OTHER	PA	AETNA PPO
6	0065091803	OTHER	PA	AMERICHOICE
7	041820	OTHER	PA	HIGHMARK BLUE SHIELD
8	30016926	OTHER	PA	KEYSTONE MERCY HEALTH
9	544680	OTHER	PA	COVENTRY HEALTH AMERICA
10	3Y6946	OTHER	PA	HEALTH NET
11	5576	OTHER	PA	BRAVO HEALTH

General Provider Information

NPI Number	:	1407830086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY SAUL KRAMER DO

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-602-8500
Fax Number	:	215-676-6507

Provider Business Practice Location Address
First Line	:	9331 OLD BUSTLETON AVE
Second Line	:	SUITE 201
City	:	PHILA
State	:	PA
Zip	:	19115-4634
Country	:	US
Telephone Number	:	215-602-8500
Fax Number	:	215-676-6507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	10/10/2013

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