Provider Demographics
NPI:1053407338
Name:KRAVITZ, SETH P (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:P
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2808
Mailing Address - Country:US
Mailing Address - Phone:845-790-6718
Mailing Address - Fax:
Practice Address - Street 1:104 FULTON AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2808
Practice Address - Country:US
Practice Address - Phone:845-790-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134008502Medicaid
TX134008509Medicaid
TX8B4125Medicare PIN
TX8B4124Medicare PIN
TX134008502Medicaid
TX8B4269Medicare PIN