Healthcare Provider Details

I. General information

NPI: 1568653558
Provider Name (Legal Business Name): DAVID M. KLINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 HADDON AVE
CAMDEN NJ
08103-3109
US

IV. Provider business mailing address

500 GROVE ST
HADDON HEIGHTS NJ
08035-1736
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3700
  • Fax:
Mailing address:
  • Phone: 856-796-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMB082847
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0139971
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: