Provider Demographics
NPI:1003844499
Name:KLIEFOTH, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:KLIEFOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:240 MIDDLETOWN BOULEVARD
Practice Address - Street 2:STE 101C
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1818
Practice Address - Country:US
Practice Address - Phone:215-750-6010
Practice Address - Fax:215-750-6012
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004863L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010614860006Medicaid
PA1286446OtherCIGNA
PA1324152OtherFIRST HEALTH
PA1382157OtherPHCS
PA07336OtherHEALTH PARTNERS
PA30003803OtherKEYSTONE MERCY
PA3109104OtherAETNA HMO
PA020054401OtherRAILROAD MEDICARE
PA0010614860003Medicaid
PA0010614860005Medicaid
PA136219OtherHIGHMARK BLUE SHIELD
PA770065OtherUNITED HEALTHCARE
PA0010614860004Medicaid
PA0052070000OtherKEYSTONE, IBC
PA01061486-03OtherAMERICHOICE
PA20045124OtherAMERIHEALTH
PA136219OtherPERSONAL CHOICE
PA1324152OtherFIRST HEALTH
PA0010614860005Medicaid