1437138724 NPI number — JANE ELLEN KLINK PT

Table of content: JANE ELLEN KLINK PT (NPI 1437138724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437138724 NPI number — JANE ELLEN KLINK PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLINK
Provider First Name:
JANE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1437138724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2608 MARKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21769-8302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-371-8464
Provider Business Mailing Address Fax Number:
301-662-8762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
84 THOMAS JOHNSON CT
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-662-8541
Provider Business Practice Location Address Fax Number:
301-662-8762
Provider Enumeration Date:
01/13/2006

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: 225100000X , with the licence number:  16978 , 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)

  • Identifier: 531555-06 . This is a "CAREFIRST MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 531555-05 . This is a "CAREFIRST MD FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R559-0010 . This is a "CAP FED BC FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 334552 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3116439 . This is a "MAMSI MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 551810 . This is a "MAMSI FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K134-0007 . This is a "CAP FED BC MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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