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NPI Code Detail

MEDICARE: DR. NANCY ANN KLUG PSYD

MEDICARE: DR. NANCY ANN KLUG PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6215MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WO5077OTHERMABCBS OF MA
2754054OTHERMATUFTS HEALTH PLAN

General Provider Information

NPI Number : 1699811109
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANCY ANN KLUG PSYD
Provider Business Mailing Address
First Line : 2557 MASSACHUSETTS AVE
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02140-1020
Country : US
Telephone Number : 617-661-5915
Fax Number :
Provider Business Practice Location Address
First Line : 2557 MASSACHUSETTS AVE
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02140-1020
Country : US
Telephone Number : 617-661-5915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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