Provider Demographics
NPI:1548333891
Name:KLEIN, KRISTINE ANN (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 NEW LOUDON ROAD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5701
Mailing Address - Country:US
Mailing Address - Phone:518-783-1472
Mailing Address - Fax:518-783-1605
Practice Address - Street 1:585 NEW LOUDON ROAD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5701
Practice Address - Country:US
Practice Address - Phone:518-783-1472
Practice Address - Fax:518-783-1605
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02425116Medicaid
I20261Medicare UPIN
RA4753Medicare ID - Type Unspecified