Basic Information
Provider Information
NPI: 1972711661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLINE
FirstName: ADAM
MiddleName: MICHAEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 37090
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212973090
CountryCode: US
TelephoneNumber: 7032959360
FaxNumber: 7032959369
Practice Location
Address1: 4320 SEMINARY RD
Address2:  
City: ALEXANDRIA
State: VA
PostalCode: 223041535
CountryCode: US
TelephoneNumber: 7035043789
FaxNumber: 7032959369
Other Information
ProviderEnumerationDate: 05/18/2007
LastUpdateDate: 09/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X0101249955VAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home