Healthcare Provider Details

I. General information

NPI: 1770508210
Provider Name (Legal Business Name): DENNIS GARY KLEBAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19119 ROCKVILLE PIKE
ROCKVILLE MD
20852
US

IV. Provider business mailing address

9804 CLYDESDALE ST
POTOMAC MD
20854-4708
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-7007
  • Fax:
Mailing address:
  • Phone: 301-299-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD15340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: