1780652461 NPI number — MARK A KLEMPERER M.D.

Table of content: MARK A KLEMPERER M.D. (NPI 1780652461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780652461 NPI number — MARK A KLEMPERER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEMPERER
Provider First Name:
MARK
Provider Middle Name:
A
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:
1780652461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
09/18/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301C US ROUTE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04074-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-396-8600
Provider Business Mailing Address Fax Number:
207-396-8632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NORWAY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04268-5645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-743-7605
Provider Business Practice Location Address Fax Number:
207-743-1579
Provider Enumeration Date:
03/09/2006

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: 207V00000X , with the licence number:  MD13261 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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