Provider Demographics
NPI:1609896273
Name:KRUGER, GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:KRUGER
Suffix:
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 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3096
Mailing Address - Country:US
Mailing Address - Phone:860-482-5384
Mailing Address - Fax:860-489-1799
Practice Address - Street 1:19 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2012
Practice Address - Country:US
Practice Address - Phone:860-364-0531
Practice Address - Fax:860-496-4951
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT24325207RH0003X
CT024325207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-1088532OtherTAX ID #
CT001243252Medicaid
CT11353OtherCT CONTROLLED SUBSTANCE
CT24325OtherCT. LICENSE
AK1609013OtherDEA
AK1609013OtherDEA
110005735Medicare ID - Type Unspecified
C00633Medicare ID - Type UnspecifiedMR GROUP #
CT24325OtherCT. LICENSE
CT110111364Medicare PIN