Healthcare Provider Details

I. General information

NPI: 1255439626
Provider Name (Legal Business Name): ERIC J. KRAUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CROSSROADS DR STE 355
OWINGS MILLS MD
21117-5494
US

IV. Provider business mailing address

21 CROSSROADS DR STE 355
OWINGS MILLS MD
21117-5494
US

V. Phone/Fax

Practice location:
  • Phone: 443-213-5427
  • Fax: 443-548-3827
Mailing address:
  • Phone: 443-213-5427
  • Fax: 443-548-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0071795
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0071795
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: