MEDICARE: MR. CHRISTOPHER KRUG PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001605-1	NY
2	363AM0700X	Medical Physician Assistant	MA003322L	PA

General Provider Information

NPI Number	:	1316918097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER KRUG PA

Provider Business Mailing Address
First Line	:	4124 JUSTIN CT
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-4131
Country	:	US
Telephone Number	:	610-831-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 EAGLEVILLE ROAD
Second Line	:	MONTGOMERY COUNTY CORRECTIONAL FACILITY
City	:	EAGLEVILLE
State	:	PA
Zip	:	19403-0000
Country	:	US
Telephone Number	:	610-635-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/10/2012

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