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General NPI Number Information
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NPI Number | 1417049867
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE INTERNAL MEDICINE AND GERIATRICS PA
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 724 FIFTH AVENUE WEST
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City | HENDERSONVILLE
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State | NC
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Zip | 28739
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Country | US
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Telephone | 828-693-6566
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Fax | 828-693-6765
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Provider Business Mailing Address
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Address Line | 724 FIFTH AVENUE WEST
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City | HENDERSONVILLE
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State | NC
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Zip | 28739
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Country | US
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Telephone | 828-693-6566
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Fax | 828-693-6765
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. PHILLIP M KLEIN
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Credential |
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Telephone | 828-693-6566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 103068
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License Number State | NC
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