Provider Demographics
NPI:1043499007
Name:KRONCKE WOUND MANAGEMENT PLLC
Entity Type:Organization
Organization Name:KRONCKE WOUND MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRONCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-903-3124
Mailing Address - Street 1:156 CANDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2107
Mailing Address - Country:US
Mailing Address - Phone:252-903-3124
Mailing Address - Fax:
Practice Address - Street 1:156 CANDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2107
Practice Address - Country:US
Practice Address - Phone:252-903-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16896208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950441Medicaid
208004AMedicare PIN