Healthcare Provider Details

I. General information

NPI: 1174571863
Provider Name (Legal Business Name): BARBARA A. KLATCHKO, M.D., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 12TH ST
LEBANON PA
17042-6617
US

IV. Provider business mailing address

402 S 12TH ST
LEBANON PA
17042-6617
US

V. Phone/Fax

Practice location:
  • Phone: 717-274-5200
  • Fax: 717-274-5440
Mailing address:
  • Phone: 717-274-5200
  • Fax: 717-274-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD044211E
License Number StatePA

VIII. Authorized Official

Name: BARBARA A. KLATCHKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 717-274-5440