1619073731 NPI number — ERIC PAUL KLAGE PA

Table of content: ERIC PAUL KLAGE PA (NPI 1619073731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619073731 NPI number — ERIC PAUL KLAGE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLAGE
Provider First Name:
ERIC
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619073731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LANDSTUHL REGIONAL MEDICAL CENTER
Provider Second Line Business Mailing Address:
CMR 467 BOX 1169
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09096
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LANDSTUHL REGIONAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
CMR 402
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09180
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
496371868590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)