Provider Demographics
NPI:1902829385
Name:KRULL, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:KRULL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1743
Mailing Address - Country:US
Mailing Address - Phone:610-644-8069
Mailing Address - Fax:610-644-6736
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-644-8069
Practice Address - Fax:610-644-6736
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA073234L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH39162Medicare UPIN
PAKR048570Medicare ID - Type Unspecified