Healthcare Provider Details

I. General information

NPI: 1730143579
Provider Name (Legal Business Name): LINDA SUE KRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELM AVE SE 6TH FLOOR NEONATOLOGY
ROANOKE VA
24013-2222
US

IV. Provider business mailing address

5212 FALCON RIDGE RD
ROANOKE VA
24018-8623
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-9840
  • Fax:
Mailing address:
  • Phone: 540-989-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101034275
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: