1679816474 NPI number — MRS. KRISTAL ELLISTON PRATHER M.D.

Table of content: MRS. KRISTAL ELLISTON PRATHER M.D. (NPI 1679816474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679816474 NPI number — MRS. KRISTAL ELLISTON PRATHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRATHER
Provider First Name:
KRISTAL
Provider Middle Name:
ELLISTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLISTON
Provider Other First Name:
KRISTAL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679816474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 SAINT PAUL ST
Provider Second Line Business Mailing Address:
APT. 1612
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202-2619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-580-0782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE JOHNS HOPKINS HOSPITAL
Provider Second Line Business Practice Location Address:
1800 ORLEANS STREET
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-2727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D81391 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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