Basic Information
| Provider Information | |||||||||
| NPI: | 1881765253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 859 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MALTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437589007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409626111 | ||||||||
| FaxNumber: | 7409622182 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 S 15TH ST | ||||||||
| Address2: | |||||||||
| City: | COSHOCTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 438122285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402953331 | ||||||||
| FaxNumber: | 7402953332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 05/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | 35-039210 | OH | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 207R00000X | 35.039210 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0327579 | 05 | OH | MEDICAID |