ETHAN KRUG MD - NPI 1164263190 - Student in an Organized Health Care Education/Training Program in Burlington, MA

Q: What is the provider's specialty?

The provider's specialty is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

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About Ethan Krug Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN KRUG MD (NPI 1164263190) is an individual student in an organized health care education/training program in Burlington, Massachusetts, licensed in Massachusetts (3017222) and active in the NPI registry since June 2024.

NPPES Registry Identity

NPI1164263190

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameETHAN KRUGCredential: MD

Location Address41 MALL RDBurlington, MA 01805-0001

Mailing Address10 Roberts St Apt 15Somerville, MA 02145-2552 · (347) 852-5831

Phone(781) 744-5100

Sole ProprietorNo

Enumeration DateJune 4, 2024

NPPES CertifiedJune 4, 2024

✔ NPI 1164263190 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MA · 3017222

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

41 MALL RD, Burlington, MA 01805

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