Provider Demographics
NPI:1053415356
Name:HERBERT L KRONTHAL MD PA
Entity type:Organization
Organization Name:HERBERT L KRONTHAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRONTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-377-4430
Mailing Address - Street 1:6301 N CHARLES STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1094
Mailing Address - Country:US
Mailing Address - Phone:410-377-4430
Mailing Address - Fax:410-377-4437
Practice Address - Street 1:6301 N CHARLES STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1094
Practice Address - Country:US
Practice Address - Phone:410-377-4430
Practice Address - Fax:410-377-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-02-22
Deactivation Date:2007-10-22
Deactivation Code:
Reactivation Date:2010-02-22
Provider Licenses
StateLicense IDTaxonomies
MDD0006036207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5071Medicare ID - Type Unspecified
B67182Medicare UPIN