1164684965 NPI number — DR. TIMOTHY MACKEY KLEPPER M.D.

Table of content: DR. TIMOTHY MACKEY KLEPPER M.D. (NPI 1164684965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164684965 NPI number — DR. TIMOTHY MACKEY KLEPPER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEPPER
Provider First Name:
TIMOTHY
Provider Middle Name:
MACKEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164684965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 BENFIELD BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MILLERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21108-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-729-5100
Provider Business Mailing Address Fax Number:
443-679-1382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 SHOREWAY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
QUEENSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21658-1681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-827-4001
Provider Business Practice Location Address Fax Number:
410-827-4333
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MT193967 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: D77286 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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