Healthcare Provider Details

I. General information

NPI: 1487645453
Provider Name (Legal Business Name): ROBERT ELLIOTT KRAFTOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 LEBANON CHURCH RD CENTURY III MEDICAL ASSOCIATES
WEST MIFFLIN PA
15122-2461
US

IV. Provider business mailing address

2027 LEBANON CHURCH RD CENTURY III MEDICAL ASSOCIATES
WEST MIFFLIN PA
15122-2461
US

V. Phone/Fax

Practice location:
  • Phone: 412-655-6403
  • Fax: 412-655-6400
Mailing address:
  • Phone: 412-655-8650
  • Fax: 412-655-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD028823E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD028823E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: