Provider Demographics
NPI:1538453717
Name:KLEMICK, FREDERICK PETER (DO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:PETER
Last Name:KLEMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BLAKELY RD
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1443
Mailing Address - Country:US
Mailing Address - Phone:610-873-1863
Mailing Address - Fax:
Practice Address - Street 1:2500 LISBURN RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-8005
Practice Address - Country:US
Practice Address - Phone:717-737-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S004158L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice