MEDICARE: DR. LARRY H. KRETCHMAR MD

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	208800000X	Urology Physician	C22535	CA

General Provider Information

NPI Number	:	1588612899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY H. KRETCHMAR MD

Provider Business Mailing Address
First Line	:	2490 HOSPITAL DR
Second Line	:	SUITE 210
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-4122
Country	:	US
Telephone Number	:	650-962-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2490 HOSPITAL DR STE 210
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-4117
Country	:	US
Telephone Number	:	650-962-4662
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/06/2020

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