Basic Information
| Provider Information | |||||||||
| NPI: | 1699713610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUG | ||||||||
| FirstName: | ESTHER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64264 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105585238 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2435 W BELVEDERE AVE | ||||||||
| Address2: | SUITE 56 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015961 | ||||||||
| FaxNumber: | 4106019390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 06/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0059273 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | D0059273 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 07708152/01 | 05 | MD | MEDICAID | CC3778 | 01 | MD | R/R MEDICARE GROUP # | OTHER | 510109300 | 05 | MD | MEDICAID | 110245394 | 01 | MD | R/R MEDICARE PROVIDER # | OTHER |