Provider Demographics
NPI:1881696193
Name:KNOLL, ROLF (MD)
Entity type:Individual
Prefix:
First Name:ROLF
Middle Name:
Last Name:KNOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:20 ISHAM RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2204
Practice Address - Country:US
Practice Address - Phone:860-527-1669
Practice Address - Fax:860-527-1669
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84422Medicare UPIN
CT110009523Medicare ID - Type Unspecified