Provider Demographics
NPI:1164131496
Name:KROLL, TIMOTHY A
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:KROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HARDWICK RD
Mailing Address - Street 2:
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-9723
Mailing Address - Country:US
Mailing Address - Phone:415-240-2906
Mailing Address - Fax:
Practice Address - Street 1:170 HARDWICK RD
Practice Address - Street 2:
Practice Address - City:PETERSHAM
Practice Address - State:MA
Practice Address - Zip Code:01366-9723
Practice Address - Country:US
Practice Address - Phone:415-240-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist