Healthcare Provider Details

I. General information

NPI: 1174720866
Provider Name (Legal Business Name): CHRISTOPHER R KLIMEK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR STE 308
FISHERSVILLE VA
22939-2273
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7190
  • Fax: 540-245-7191
Mailing address:
  • Phone: 540-932-5162
  • Fax: 540-932-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2160-023
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007249
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: