Provider Demographics
NPI:1508800806
Name:KROO, MARTA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:J
Last Name:KROO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4819
Mailing Address - Fax:860-358-4809
Practice Address - Street 1:136 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2627
Practice Address - Country:US
Practice Address - Phone:860-632-5570
Practice Address - Fax:860-635-0097
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT034064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1340645Medicaid
CT080001187Medicare PIN
CTG03328Medicare UPIN