Healthcare Provider Details

I. General information

NPI: 1558692533
Provider Name (Legal Business Name): STEVEN G. KLOTZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2461 LITITZ PIKE
LANCASTER PA
17601-3670
US

IV. Provider business mailing address

2461 LITITZ PIKE
LANCASTER PA
17601-3670
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-3525
  • Fax: 717-560-3995
Mailing address:
  • Phone: 717-560-3525
  • Fax: 717-560-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMD428192
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberMD428192
License Number StatePA

VIII. Authorized Official

Name: STEVEN G KLOTZ
Title or Position: PRESIDENT
Credential: MD
Phone: 717-560-3525