Provider Demographics
NPI:1548282254
Name:KLAIN, HEASLEY, NETTLETON MD PC
Entity type:Organization
Organization Name:KLAIN, HEASLEY, NETTLETON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:KLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-459-9111
Mailing Address - Street 1:25 COLONY BOULEVARD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-7971
Mailing Address - Country:US
Mailing Address - Phone:724-459-9111
Mailing Address - Fax:724-459-7856
Practice Address - Street 1:25 COLONY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7971
Practice Address - Country:US
Practice Address - Phone:724-459-9111
Practice Address - Fax:724-459-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE40067Medicare UPIN
PA046021Medicare ID - Type Unspecified
PA598217Medicare PIN