Basic Information
| Provider Information | |||||||||
| NPI: | 1962423327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1745 N MILLS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078417151 | ||||||||
| FaxNumber: | 4074252768 | ||||||||
| Practice Location | |||||||||
| Address1: | 1745 N MILLS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078417151 | ||||||||
| FaxNumber: | 4074252768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME-0054751 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 2007-00323 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | ME0054751 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 145V1 | 01 | NC | BCBS-NC | OTHER | 1937719004 | 01 | CIGNA | OTHER | 254736800 | 05 | FL | MEDICAID | 592171328-001 | 01 | CHAMPUS/TRICARE | OTHER | P00416538 | 01 | RAILROAD MEDICARE | OTHER | Q0032D | 05 | SC | MEDICAID | 060046816 | 01 | RAILROAD MEDICARE | OTHER | 14692 | 01 | FL | BLUE SHIELD | OTHER | 210450 | 01 | WELLCARE | OTHER | 5231011 | 01 | AETNA | OTHER | 6005750 | 01 | GHI | OTHER | 5906501 | 05 | NC | MEDICAID |