Provider Demographics
NPI:1558706556
Name:KROLL, RICHARD SR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:KROLL
Suffix:SR
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 1:1980 CATASAUQUA RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-3100
Mailing Address - Country:US
Mailing Address - Phone:610-266-1177
Mailing Address - Fax:610-266-1179
Practice Address - Street 1:1980 CATASAUQUA RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-3100
Practice Address - Country:US
Practice Address - Phone:610-266-1177
Practice Address - Fax:610-266-1179
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACO099652L247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other