1770528648 NPI number — PAVEL KLEIN MD

Table of content: PAVEL KLEIN MD (NPI 1770528648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770528648 NPI number — PAVEL KLEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
PAVEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1770528648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6410 ROCKLEDGE DRIVE, #610
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20817
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
301-530-9744
Provider Business Mailing Address Fax Number:
301-530-0046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 ROCKLEDGE DRIVE, #610
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
301-530-9744
Provider Business Practice Location Address Fax Number:
301-530-0046
Provider Enumeration Date:
06/17/2006

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: 2084N0400X , with the licence number:  D0054270 , 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: 3117668 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521186611 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9070 0036 . This is a "BSDC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3117668 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1453333 . This is a "CIGNA PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 687510-04 . This is a "BSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3117668 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 311100801 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3117668 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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