Healthcare Provider Details

I. General information

NPI: 1073516415
Provider Name (Legal Business Name): MICHAEL ELIHU KLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 NORRISVILLE ROAD
JARRETTSVILLE MD
21084-1838
US

IV. Provider business mailing address

3714 NORRISVILLE ROAD
JARRETTSVILLE MD
21084-1838
US

V. Phone/Fax

Practice location:
  • Phone: 410-504-9511
  • Fax: 888-691-8524
Mailing address:
  • Phone: 410-504-9511
  • Fax: 888-691-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberD17515
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD028674E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD17515
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: