Healthcare Provider Details

I. General information

NPI: 1043471394
Provider Name (Legal Business Name): STEPHEN J. KROLL, M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 HARBISON BLVD
COLUMBIA SC
29212-2248
US

IV. Provider business mailing address

338 HARBISON BLVD
COLUMBIA SC
29212-2248
US

V. Phone/Fax

Practice location:
  • Phone: 803-732-6655
  • Fax:
Mailing address:
  • Phone: 803-732-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number7485
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number7485
License Number StateSC

VIII. Authorized Official

Name: DR. STEPHEN J KROLL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-732-6655