Provider Demographics
NPI:1912921644
Name:KRIEGER, MITCHEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:D
Last Name:KRIEGER
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 1:29 HOSPITAL PLZ STE 603
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-2002
Mailing Address - Fax:203-276-2259
Practice Address - Street 1:29 HOSPITAL PLZ STE 603
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-2002
Practice Address - Fax:203-276-2259
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75472208200000X
VA0101055986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA39070001OtherCARE FIRST BLUE CHOICE
VA006901107Medicaid
VA204010OtherANTHEM BLUE CROSS BLUE SH
VA204010OtherANTHEM BLUE CROSS BLUE SH
G566312Medicare UPIN