Healthcare Provider Details

I. General information

NPI: 1174521736
Provider Name (Legal Business Name): HARVEY J KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 PEARL ST., SUITE 10
BURLINGTON VT
05401-8543
US

IV. Provider business mailing address

267 PEARL ST SUITE 10
BURLINGTON VT
05401-8564
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-5300
  • Fax: 802-658-2067
Mailing address:
  • Phone: 802-658-5300
  • Fax: 802-658-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42-0005410
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: