Provider Demographics
NPI:1184683062
Name:KROL, ALICIA MARIE PIELOW (PA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE PIELOW
Last Name:KROL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14214 BALLANTYNE LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3372
Practice Address - Country:US
Practice Address - Phone:704-667-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184683062Medicaid
SC2294PAMedicaid
NCNC4850FMedicare PIN
Q65201Medicare UPIN
NC0480730001Medicare NSC
NC2765712BMedicare PIN
NCNC4850BMedicare PIN
SC2294PAMedicaid
NCNC4850AMedicare PIN
NC2765712AMedicare PIN
NCNC4850DMedicare PIN
NC1184683062Medicaid
NCNC4850EMedicare PIN
NCNC4850GMedicare PIN