Basic Information
| Provider Information | |||||||||
| NPI: | 1144239906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177418003 | ||||||||
| FaxNumber: | 7177418016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD029009L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | MD029009L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 81788 | 01 | PA | UNISON-WMG | OTHER | 5137088 | 01 | PA | AETNA | OTHER | P002843 | 01 | PA | GATEWAY-WMG | OTHER | 50054294 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 2143029 | 01 | PA | MAMSI-WMG | OTHER | 647977 | 01 | MD | CAREFIRST MD BCBS | OTHER | 031972 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 030056 | 01 | PA | JOHNS HOPKINS | OTHER | 39637 | 01 | PA | GEISINGER | OTHER | 0068486000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 1142280 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER |