Provider Demographics
NPI:1124020011
Name:KROLL, PETER B (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:KROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE ROAD
Mailing Address - Street 2:160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:855-540-4722
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:SUITE 122B
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-824-3737
Practice Address - Fax:855-540-4722
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036963207LP2900X
TN36963207L00000X
TNMD36963207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00450337OtherRAILROAD MEDICARE
TN7502422OtherAETNA
TN3377000Medicaid
TN10069948OtherAMERIGROUP
TN3878748Medicaid
TN4129006OtherBCBS
TN7502422OtherAETNA
TNP00450337OtherRAILROAD MEDICARE
TN3878747Medicare ID - Type Unspecified