Provider Demographics
NPI:1356041776
Name:KLEIN, AVI
Entity type:Individual
Prefix:
First Name:AVI
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9199 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9199 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:MD
Practice Address - Zip Code:21117-4520
Practice Address - Country:US
Practice Address - Phone:443-898-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily