Healthcare Provider Details

I. General information

NPI: 1073617452
Provider Name (Legal Business Name): MARY MCNERNEY KLOTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW ROOM 1J - ALLERGY
WASHINGTON DC
20307-5001
US

IV. Provider business mailing address

6900 GEORGIA AVE NW ROOM 1J - ALLERGY
WASHINGTON DC
20307-5001
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6848
  • Fax: 202-782-7093
Mailing address:
  • Phone: 202-782-6848
  • Fax: 202-782-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberD0056857
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: