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NPI Code Detail

MEDICARE: ANDREW KLANSKY PA-C

MEDICARE:   ANDREW  KLANSKY  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225592785
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW KLANSKY PA-C
Provider Business Mailing Address
First Line : PO BOX 253
Second Line :
City : THETFORD CENTER
State : VT
Zip : 05075-0253
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3925 N LECANTO HWY
Second Line :
City : BEVERLY HILLS
State : FL
Zip : 34465-3507
Country : US
Telephone Number : 352-527-7336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 01/29/2019

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