Healthcare Provider Details

I. General information

NPI: 1720155385
Provider Name (Legal Business Name): DOUGLAS KLEINMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DEPT OF ORTHOPAEDICS
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-8949
  • Fax: 603-650-8869
Mailing address:
  • Phone: 603-650-8949
  • Fax: 603-650-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0697
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1593
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: