Healthcare Provider Details

I. General information

NPI: 1255167110
Provider Name (Legal Business Name): PAVEL KLEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N GEORGE MASON DR STE 107
ARLINGTON VA
22205-3642
US

IV. Provider business mailing address

PO BOX 782438
PHILADELPHIA PA
19178-2438
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-9744
  • Fax: 301-530-0046
Mailing address:
  • Phone: 301-530-9745
  • Fax: 301-530-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCELO E LANCMAN
Title or Position: AUTHORIZED OFFICIAL/PROVIDER/PARTNE
Credential:
Phone: 914-428-3651