Healthcare Provider Details

I. General information

NPI: 1467495788
Provider Name (Legal Business Name): PETER S KLEIN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 15 PENN TOWER
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE STREET 15 PENN TOWER
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD055837L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: