Basic Information
| Provider Information | |||||||||
| NPI: | 1407898216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEEMAN | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105522 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 1057 SECOND STREET PIKE | ||||||||
| Address2: | |||||||||
| City: | RICHBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153575760 | ||||||||
| FaxNumber: | 2673642005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD035499E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1222774 | 01 | PA | CIGNA | OTHER | 877557 | 01 | PA | UNITED HEALTHCARE | OTHER | PA0047081 | 01 | PA | TRICARE | OTHER | 01191856-01 | 01 | PA | AMERICHOICE | OTHER | 0011918560010 | 05 | PA | MEDICAID | 01486 | 01 | PA | HEALTH PARTNERS | OTHER | 110170082 | 01 | PA | RAILROAD MEDICARE | OTHER | 291 | 01 | PA | AETNA | OTHER | 405148 | 01 | PA | BLUE SHIELD | OTHER | 0054679000 | 01 | PA | KEYSTONE, IBC | OTHER | 1022040 | 01 | PA | KEYSTONE MERCY | OTHER | 1555092 | 01 | PA | PHCS | OTHER | 1591630 | 01 | PA | FIRST HEALTH | OTHER | 405148 | 01 | PA | PERSONAL CHOICE | OTHER | 8845 | 01 | PA | CLEARCARE | OTHER |