1790749646 NPI number — MATTHEW T KLINE M.D.

Table of content: MATTHEW T KLINE M.D. (NPI 1790749646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790749646 NPI number — MATTHEW T KLINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLINE
Provider First Name:
MATTHEW
Provider Middle Name:
T
Provider Name Prefix Text:
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:
1790749646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 12870
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19850-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-526-3536
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S BRYN MAWR AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-527-9500
Provider Business Practice Location Address Fax Number:
610-527-8166
Provider Enumeration Date:
04/15/2006

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: 207LP2900X , with the licence number:  MD029145E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: C1-0006716 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001049552 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00972273 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5658052 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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