Provider Demographics
NPI:1144215633
Name:KREBS, THORSTEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:THORSTEN
Middle Name:L
Last Name:KREBS
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 1:36 TAMARACK AVE, PMB 118
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811
Mailing Address - Country:US
Mailing Address - Phone:203-739-7532
Mailing Address - Fax:203-796-7667
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-7532
Practice Address - Fax:203-796-7667
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0376412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300003618Medicare PIN
E65695Medicare UPIN
NY572T51Medicare PIN
CT300002600Medicare PIN
NY300136366Medicare PIN
CT300108358Medicare PIN