Provider Demographics
NPI:1740211168
Name:KROESSLER, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:KROESSLER
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 1:33 COLLEGE HILL RD
Mailing Address - Street 2:BLD 29C
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2776
Mailing Address - Country:US
Mailing Address - Phone:401-822-4673
Mailing Address - Fax:401-822-4676
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:BLD 29C
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-822-4673
Practice Address - Fax:401-822-4676
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD069102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI260017981OtherRAILROAD MEDICARE
RI006910-601045OtherTUFTS HEALTH PLANS
RI30025-0OtherBLUE CROSS & BLUE SHIELD
RI05-0468084OtherUNITED HEALTH PLANS
RI050468084OtherGEHA
RI1014940Medicaid
RI200865OtherCOORDINATED HEALTH PLANS
RI007003180Medicare PIN