Healthcare Provider Details

I. General information

NPI: 1023155827
Provider Name (Legal Business Name): CHRISTOPHER AUSTIN KLEBANOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR BUILDING 10, CRC-3W-5816
BETHESDA MD
20892-1037
US

IV. Provider business mailing address

10 CENTER DR BUILDING 10, CRC-3W-5816
BETHESDA MD
20892-1037
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-5659
  • Fax:
Mailing address:
  • Phone: 301-496-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD67993
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD67993
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: