Basic Information
| Provider Information | |||||||||
| NPI: | 1801802061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAMER | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 NORTH ACADEMY AVE. | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 132 ABIGAIL LANE | ||||||||
| Address2: | |||||||||
| City: | PORT MATILDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168705700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725011 | ||||||||
| FaxNumber: | 8142726531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | G62618 | CA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | MD456768 | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 00G626180 | 05 | CA | MEDICAID | 00G626180 | 01 | CA | BLUE SHIELD | OTHER | 040016640 | 01 | CA | RAILROAD MEDICARE | OTHER |