Provider Demographics
NPI:1538264619
Name:KROLL, HEATHER ROMA (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROMA
Last Name:KROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 1ST AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4744
Mailing Address - Country:US
Mailing Address - Phone:206-859-5030
Mailing Address - Fax:206-859-5031
Practice Address - Street 1:415 1ST AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4744
Practice Address - Country:US
Practice Address - Phone:206-859-5030
Practice Address - Fax:206-859-5031
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036552208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7919156OtherAETNA
WA4300KROtherREGENCE BLUE SHIELD
WA4300KROtherREGENCE BLUE SHIELD
WA7919156OtherAETNA