Provider Demographics
NPI:1891734471
Name:KROHN, DOUGLAS RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RUSSELL
Last Name:KROHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STELTON RD
Mailing Address - Street 2:STE A
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2638
Mailing Address - Country:US
Mailing Address - Phone:732-424-0440
Mailing Address - Fax:732-424-0443
Practice Address - Street 1:24 STELTON RD
Practice Address - Street 2:STE A
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-2638
Practice Address - Country:US
Practice Address - Phone:732-424-0440
Practice Address - Fax:732-424-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1074742Medicaid
D07205Medicare UPIN
NJ478024Medicare PIN