Healthcare Provider Details

I. General information

NPI: 1215935168
Provider Name (Legal Business Name): ROBERT KRUG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 BLUE HILLS AVE
HARTFORD CT
06112-1513
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 2109A
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-2647
  • Fax: 860-714-8517
Mailing address:
  • Phone: 860-714-6581
  • Fax: 860-714-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number035323
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: