Healthcare Provider Details

I. General information

NPI: 1033967138
Provider Name (Legal Business Name): ABIGAIL MARIE KROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 215
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

3780 MYSTIC VALLEY PKWY APT 160
MEDFORD MA
02155-6938
US

V. Phone/Fax

Practice location:
  • Phone: 202-466-9719
  • Fax:
Mailing address:
  • Phone: 978-833-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: