1639477565 NPI number — FREDRIC B. KLEINER, PH.D. & ASSOCIATES, P.C.

Table of content: (NPI 1639477565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639477565 NPI number — FREDRIC B. KLEINER, PH.D. & ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDRIC B. KLEINER, PH.D. & ASSOCIATES, P.C.
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:
6
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:
1639477565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 E WEST HWY
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-4523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-652-2120
Provider Business Mailing Address Fax Number:
301-657-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 E WEST HWY
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-652-2120
Provider Business Practice Location Address Fax Number:
301-657-9224
Provider Enumeration Date:
03/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KLEINER
Authorized Official First Name:
FREDRIC
Authorized Official Middle Name:
BARRY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-652-2120

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  00640 , 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: 9496009 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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