Provider Demographics
NPI:1174584643
Name:KRONLUND, KENNETH H JR (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:KRONLUND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 NEPONSET ST FL STREET2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-595-2021
Practice Address - Street 1:378 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2673
Practice Address - Country:US
Practice Address - Phone:508-595-2513
Practice Address - Fax:508-595-2021
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9900163OtherFALLON COMMUNITY HEALTH P
J04115OtherMEDICARE B
0401681OtherEVERCARE
27526OtherHEALTHY START
3100898OtherMEDICAID WELFARE
5804464OtherAETNA US HEALTHCARE
AA1229OtherHARVARD PILGRIM HEALTHCAR
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherONE HEALTH PLAN
J04115OtherBLUE SHIELD HMO BLUE
MA3100898Medicaid
2704712OtherCIGNA HEALTH PLAN
042472266OtherTHREE RIVERS
1060840OtherFIRST HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
110145175OtherRAILROAD MEDICARE
J04115OtherBLUE SHIELD INDEMNITY
J04115OtherBLUE CARE ELECT
B98827Medicare UPIN
MAJ04115Medicare ID - Type Unspecified