Healthcare Provider Details

I. General information

NPI: 1356516298
Provider Name (Legal Business Name): DAVID KENNETH KRUG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/18/2022
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW SUITE 205
WASHINGTON DC
20036-3701
US

IV. Provider business mailing address

PO BOX 4196
COLUMBUS GA
31914-0196
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-4490
  • Fax: 301-279-4489
Mailing address:
  • Phone: 301-279-4490
  • Fax: 301-279-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number128226
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number88334
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: