MEDICARE: ROLF KNOLL MD

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	207R00000X	Internal Medicine Physician	022935	CT

General Provider Information

NPI Number	:	1881696193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLF KNOLL MD

Provider Business Mailing Address
First Line	:	30 JORDAN LN
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-1278
Country	:	US
Telephone Number	:	860-263-0253
Fax Number	:	860-263-0262

Provider Business Practice Location Address
First Line	:	20 ISHAM RD
Second Line	:	SUITE 150
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2204
Country	:	US
Telephone Number	:	860-527-1669
Fax Number	:	860-527-1669

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/19/2013

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