Provider Demographics
NPI:1720078439
Name:KRONTHAL, ALAN J (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:KRONTHAL
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:PO BOX 4196
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31914-0196
Mailing Address - Country:US
Mailing Address - Phone:706-653-1102
Mailing Address - Fax:706-653-1203
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:202-660-7642
Practice Address - Fax:202-363-6984
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD200712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016129D23Medicare PIN
F32140Medicare UPIN
VAP00442432Medicare PIN
VA015536C19Medicare PIN