Healthcare Provider Details

I. General information

NPI: 1063491728
Provider Name (Legal Business Name): DOUGLAS K KLAMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

IV. Provider business mailing address

746 JEFFERSON AVE STE 301
SCRANTON PA
18510-1624
US

V. Phone/Fax

Practice location:
  • Phone: 570-941-0630
  • Fax:
Mailing address:
  • Phone: 570-346-7422
  • Fax: 570-346-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD061283L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier016736300001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: