Provider Demographics
NPI:1508051459
Name:KRIL, MERVIN PETER (MD)
Entity Type:Individual
Prefix:
First Name:MERVIN
Middle Name:PETER
Last Name:KRIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:120 N AUBURN ST STE 115
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6277
Practice Address - Country:US
Practice Address - Phone:916-576-7916
Practice Address - Fax:530-615-4995
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31299207T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A312990Medicare PIN