Basic Information
| Provider Information | |||||||||
| NPI: | 1124067822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 TWIN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | HALETHORPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104840748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 TWIN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | HALETHORPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107375000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | D0053495 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 119404600 | 05 | MD | MEDICAID |