Provider Demographics
NPI:1134211980
Name:KROL, KELLY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:KROL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 HANOVER PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2011
Mailing Address - Country:US
Mailing Address - Phone:301-220-0496
Mailing Address - Fax:301-220-2303
Practice Address - Street 1:7500 HANOVER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2011
Practice Address - Country:US
Practice Address - Phone:301-220-0496
Practice Address - Fax:301-220-2303
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02144225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2319521OtherUNITED HEALTHCARE
MD7152476OtherAETNA PROVIDER NON HMO
MD1039616OtherASHN/CIGNA
MD2120466OtherMAMSI/MDIPA/OPT./ALLIANCE
MD652646OtherACN
MD3191047OtherAETNA PROVIDER HMO
MD2096858OtherFIRST HEALTH/MAILHANDLERS
MD61837401OtherCAREFIRST BCBS MD
MDG7520002OtherCAREFIRST BCBS DC