Healthcare Provider Details

I. General information

NPI: 1720070444
Provider Name (Legal Business Name): ARTHUR W KLOSSNER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PEARL ST
BURLINGTON VT
05401-3308
US

IV. Provider business mailing address

425 PEARL ST
BURLINGTON VT
05401-3308
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-3350
  • Fax: 802-656-8178
Mailing address:
  • Phone: 802-656-3350
  • Fax: 802-656-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1464
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: