1235383738 NPI number — KENNETH KLEIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235383738 NPI number — KENNETH KLEIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNETH KLEIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EAST CAROLINA DERMATOLOGY AND SKIN SURGERY, PLLC
Provider Other Organization Name Type Code:
3
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:
1235383738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MCCARTHY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-5231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-633-4200
Provider Business Mailing Address Fax Number:
252-633-9263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MCCARTHY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-633-4200
Provider Business Practice Location Address Fax Number:
252-633-9263
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
252-633-4200

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8949680 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49680 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207N00000X . This is a "MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2183602 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: F38755 . This is a "UPIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1174507990 . This is a "NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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