Individual
LARRY E KREVOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
235 N BROAD ST, SUITE 200 CLINICAL NEPHROLOGY ASSOC, PHILADELPHIA, PA 19107-1511
(215) 762-7785
(215) 568-6007
Mailing address
235 N BROAD ST, SUITE 200, PHILADELPHIA, PA 19107-1511
(215) 762-7785
(215) 568-6007
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
05003817L
PA
207RN0300X
Nephrology Physician
25MB03667100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000792539
—
PA
Enumeration date
09/23/2006
Last updated
12/16/2010
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