Provider Demographics
NPI:1437113685
Name:KROLL, BARRY SCOTT
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:SCOTT
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 1:4829 E STREET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6647
Mailing Address - Country:US
Mailing Address - Phone:215-364-5800
Mailing Address - Fax:215-364-5899
Practice Address - Street 1:4829 E STREET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6647
Practice Address - Country:US
Practice Address - Phone:215-364-5800
Practice Address - Fax:215-364-5899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053383L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF96192Medicare UPIN