1174571863 NPI number — BARBARA A. KLATCHKO, M.D., LTD.

Table of content: (NPI 1174571863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174571863 NPI number — BARBARA A. KLATCHKO, M.D., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA A. KLATCHKO, M.D., LTD.
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:
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:
1174571863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 S 12TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042-6617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-274-5200
Provider Business Mailing Address Fax Number:
717-274-5440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 S 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-6617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-274-5200
Provider Business Practice Location Address Fax Number:
717-274-5440
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLATCHKO
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-274-5440

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD044211E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01968502 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1519910 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P-42051920 . This is a "MULTI-PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4253876 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 612189 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0012789490004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0612189 . This is a "HEALTH ONE" identifier . This identifiers is of the category "OTHER".




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