Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 80854 | MA |
N | 207R00000X | Internist | 80854 | MA |
N | 111NI0900X | Internist | 80854 | MA |
NPI | 1649251000 |
---|---|
Provider Name | Dr. Eric Krakauer |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 09/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080854 | TUFTS HEALTH PLAN (01) | MA |
3170314 | (05) | MA |
G74223 | (02) | |
J17996 | BCBS MA (01) | MA |