Provider Demographics
NPI:1922178557
Name:KROLL, SHERRY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LEE
Last Name:KROLL
Suffix:
Gender:F
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:PRIMARY CARE, SUITE 300
Mailing Address - Street 2:584 NORWICH ROAD
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374
Mailing Address - Country:US
Mailing Address - Phone:860-230-0020
Mailing Address - Fax:860-230-0021
Practice Address - Street 1:HARTFORD HEALTHCARE MEDICAL GROUP PRIMARY CARE
Practice Address - Street 2:584 NORWICH ROAD
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374
Practice Address - Country:US
Practice Address - Phone:860-230-0020
Practice Address - Fax:860-230-0021
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001367178Medicaid
CT110007095Medicare ID - Type Unspecified
G67396Medicare UPIN