Provider Demographics
NPI:1689643298
Name:KROHN, DAVID I (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:KROHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5205
Practice Address - Fax:781-431-5465
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA41934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPV995OtherHARVARD PILGRIM
MA714566OtherTUFTS
MA2072726Medicaid
MAB51045OtherBLUE CROSS
MAPV995OtherHARVARD PILGRIM
MAB73298Medicare UPIN