Provider Demographics
NPI:1700090636
Name:KROGEL, NATHANIEL RYAN (DO)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:RYAN
Last Name:KROGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S STERLING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4091
Mailing Address - Country:US
Mailing Address - Phone:828-580-6572
Mailing Address - Fax:828-580-6754
Practice Address - Street 1:2209 S STERLING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4091
Practice Address - Country:US
Practice Address - Phone:828-580-6752
Practice Address - Fax:828-580-6574
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NC2012-00598207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2012-00598OtherMEDICAL LICENSE