Provider Demographics
NPI:1679816474
Name:PRATHER, KRISTAL ELLISTON (MD)
Entity type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:ELLISTON
Last Name:PRATHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:
Other - Last Name:ELLISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 SAINT PAUL ST
Mailing Address - Street 2:APT. 1612
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2619
Mailing Address - Country:US
Mailing Address - Phone:407-580-0782
Mailing Address - Fax:
Practice Address - Street 1:THE JOHNS HOPKINS HOSPITAL
Practice Address - Street 2:1800 ORLEANS STREET
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics