Healthcare Provider Details

I. General information

NPI: 1285613224
Provider Name (Legal Business Name): ROBERT E KRACHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ESSEX CENTER DR
PEABODY MA
01960-2902
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 978-977-4000
  • Fax:
Mailing address:
  • Phone: 617-559-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48995
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: