1922178557 NPI number — DR. SHERRY LEE KROLL MD

Table of content: DR. SHERRY LEE KROLL MD (NPI 1922178557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922178557 NPI number — DR. SHERRY LEE KROLL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KROLL
Provider First Name:
SHERRY
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1922178557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PRIMARY CARE, SUITE 300
Provider Second Line Business Mailing Address:
584 NORWICH ROAD
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-230-0020
Provider Business Mailing Address Fax Number:
860-230-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HARTFORD HEALTHCARE MEDICAL GROUP PRIMARY CARE
Provider Second Line Business Practice Location Address:
584 NORWICH ROAD
Provider Business Practice Location Address City Name:
PLAINFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-230-0020
Provider Business Practice Location Address Fax Number:
860-230-0021
Provider Enumeration Date:
11/09/2006

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: 207R00000X , with the licence number:  036717 , 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: 001367178 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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