Basic Information
Provider Information
NPI: 1861853145
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLEIN
FirstName: ANNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2410 ATHERHOLT RD
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245012148
CountryCode: US
TelephoneNumber: 4342005252
FaxNumber: 4342002871
Practice Location
Address1: 2410 ATHERHOLT RD
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245012148
CountryCode: US
TelephoneNumber: 4342005252
FaxNumber: 4342002871
Other Information
ProviderEnumerationDate: 03/14/2016
LastUpdateDate: 10/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-06265NCN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
207RC0000X0110-007735VAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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