Provider Demographics
NPI:1255313011
Name:KRONCKE, FREDERICK GEORGE JR (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:GEORGE
Last Name:KRONCKE
Suffix:JR
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 1:200 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1470
Mailing Address - Country:US
Mailing Address - Phone:252-443-5941
Mailing Address - Fax:252-443-7059
Practice Address - Street 1:200 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1470
Practice Address - Country:US
Practice Address - Phone:252-443-5941
Practice Address - Fax:252-443-7059
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950441Medicaid
NCC85011Medicare UPIN
NC8950441Medicaid
NC208004Medicare ID - Type Unspecified