Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD027651E | PA |
NPI | 1245262476 |
---|---|
Provider Name | Mark Richard Klingensmith |
First Address | Jeannette, PA 15644-2538 |
Second Address | Greensburg, PA 15601-2820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009962070003 | (05) | PA |
B34316 | (02) | PA |