=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972711661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM MICHAEL KLINE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 09/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 SEMINARY RD
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-504-3789
-----------------------------------------------------
Fax | 703-295-9369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 37090
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21297-3090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-295-9360
-----------------------------------------------------
Fax | 703-295-9369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 0101249955
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------