Healthcare Provider Details

I. General information

NPI: 1962564443
Provider Name (Legal Business Name): CHARLES E KRAMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST MS-417
DUNEDIN FL
34698-5848
US

IV. Provider business mailing address

PO BOX 198317
ATLANTA GA
30384-8317
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-6635
  • Fax:
Mailing address:
  • Phone: 727-734-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME64486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: