Healthcare Provider Details

I. General information

NPI: 1497756647
Provider Name (Legal Business Name): ALAN D KLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PEACE HAVEN RD
WINSTON SALEM NC
27106-4851
US

IV. Provider business mailing address

2020 PEACE HAVEN RD
WINSTON SALEM NC
27106-4851
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-1280
  • Fax: 336-760-8443
Mailing address:
  • Phone: 336-768-1280
  • Fax: 336-760-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number200101456
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: