1245283241 NPI number — FRANK ANTHONY KLANDUCH M.D.

Table of content: TARA TARLETON PA-C (NPI 1831747252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245283241 NPI number — FRANK ANTHONY KLANDUCH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLANDUCH
Provider First Name:
FRANK
Provider Middle Name:
ANTHONY
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:
1245283241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 RANDOLPH RD
Provider Second Line Business Mailing Address:
STE 900
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28207-1106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-377-2424
Provider Business Mailing Address Fax Number:
704-377-2687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 RANDOLPH RD
Provider Second Line Business Practice Location Address:
STE 900
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28207-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-377-2424
Provider Business Practice Location Address Fax Number:
704-377-2687
Provider Enumeration Date:
05/18/2006

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: 207P00000X , with the licence number:  036168425 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 2005-00404 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: MD61376221 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 46794 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 59-01290 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00273991 . This is a "RR MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 139T5 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: Q04005 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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