Healthcare Provider Details

I. General information

NPI: 1427408335
Provider Name (Legal Business Name): DAVID KLEBENOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HIGH ST
NASHUA NH
03060-3312
US

IV. Provider business mailing address

77 NORTHEASTERN BLVD
NASHUA NH
03062-3161
US

V. Phone/Fax

Practice location:
  • Phone: 603-821-7788
  • Fax: 603-821-5620
Mailing address:
  • Phone: 603-882-3616
  • Fax: 603-595-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1017262
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20018
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: