Healthcare Provider Details

I. General information

NPI: 1669535068
Provider Name (Legal Business Name): JAN C KLETTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E 4TH AVE STE C
RANSON WV
25438-1617
US

IV. Provider business mailing address

2500 FOUNDATION WAY
MARTINSBURG WV
25401-9000
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-6343
  • Fax: 304-725-8808
Mailing address:
  • Phone: 304-264-9202
  • Fax: 304-264-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20334
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: