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NPI Code Detail

MEDICARE: DR. MARY S. KRAEMER MD

MEDICARE: DR. MARY S. KRAEMER 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
1207R00000XInternal Medicine Physician0101265606VA
2207R00000XInternal Medicine Physician9701797NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3110163680OTHERNCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11093HOTHERNCBCBS NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336131762
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY S. KRAEMER MD
Provider Business Mailing Address
First Line : 3 RIVERSIDE CIR
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4955
Country : US
Telephone Number : 540-224-5170
Fax Number : 540-983-8229
Provider Business Practice Location Address
First Line : 3 RIVERSIDE CIR
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4955
Country : US
Telephone Number : 540-224-5170
Fax Number : 540-983-8229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 12/10/2020

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Directions to “ DR. MARY S. KRAEMER MD” Practice Location

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