1033187455 NPI number — IAN ELLIOTT KROP MD PHD

Table of content: IAN ELLIOTT KROP MD PHD (NPI 1033187455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033187455 NPI number — IAN ELLIOTT KROP MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KROP
Provider First Name:
IAN
Provider Middle Name:
ELLIOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1033187455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 208028
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06520-8028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-785-4095
Provider Business Mailing Address Fax Number:
203-785-4116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-200-2328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2006

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: 207RX0202X , with the licence number:  71123 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 214556 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5256233 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A34074 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J24828 . This is a "MASSACHUSETTS BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3000522 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2900088 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00080815 . This is a "RR MEDICARE BINNEY MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65548 . This is a "FALLON COMMUNITY HLTH PLN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0172910 . This is a "MASSHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14797 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".




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