Provider Demographics
NPI:1144472887
Name:DR WENDY KLOESZ, M.D., P.A
Entity type:Organization
Organization Name:DR WENDY KLOESZ, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:KLOESZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-797-3152
Mailing Address - Street 1:5701 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1423
Mailing Address - Country:US
Mailing Address - Phone:443-797-3152
Mailing Address - Fax:
Practice Address - Street 1:5701 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1423
Practice Address - Country:US
Practice Address - Phone:443-797-3152
Practice Address - Fax:410-665-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty