Healthcare Provider Details

I. General information

NPI: 1356320394
Provider Name (Legal Business Name): THOMAS E KRUEGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 CAMBRIDGE ST
CAMBRIDGE MA
02138-4302
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 617-661-5500
  • Fax: 617-661-5444
Mailing address:
  • Phone: 617-559-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: