Basic Information
| Provider Information | |||||||||
| NPI: | 1205947868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2379 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411052379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064086200 | ||||||||
| FaxNumber: | 6064086612 | ||||||||
| Practice Location | |||||||||
| Address1: | 613 23RD ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411012868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063244745 | ||||||||
| FaxNumber: | 6063244941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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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 | 207RC0000X | 23894 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0081444000 | 05 | WV | MEDICAID | 0599606 | 05 | OH | MEDICAID | P110081097 | 01 | KY | RR MEDICARE | OTHER | P01312545 | 01 | KY | RR MEDICARE | OTHER | 64238942 | 05 | KY | MEDICAID | P01428750 | 01 | OH | RR MEDICARE | OTHER | P00704455 | 01 | KY | MEDICARE-RAILROAD KY | OTHER |