Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS030642L | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS030642L | PA |
N | 207L00000X | Anesthesiologist | DA031589 | PA |
NPI | 1366409799 |
---|---|
Provider Name | Steven M Krakora |
First Address | Washington, PA 15301-5892 |
Second Address | Washington, PA 15301-5892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 25/01/2021 |