Provider Demographics
NPI:1700829629
Name:KRULL, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:KRULL
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 1:361 OLD BELGRADE RD
Mailing Address - Street 2:ALFOND CANCER CENTER
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8058
Mailing Address - Country:US
Mailing Address - Phone:207-621-6100
Mailing Address - Fax:207-621-6102
Practice Address - Street 1:361 OLD BELGRADE RD
Practice Address - Street 2:ALFOND CANCER CENTER
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8058
Practice Address - Country:US
Practice Address - Phone:207-621-6100
Practice Address - Fax:207-621-6102
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015379207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME31180099Medicaid
MEMM8346Medicare ID - Type Unspecified
MEMM834601Medicare PIN
ME31180099Medicaid