Provider Demographics
NPI:1073569265
Name:KLOSTERMAN, SCOTT A (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:KLOSTERMAN
Suffix:
Gender:M
Credentials:DO
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6193
Practice Address - Fax:864-560-1510
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01221611OtherRAILROAD MEDICARE
SC0087258Medicaid
SC008725Medicaid
SCH988953365OtherMEDICARE PIN
SC0087258Medicaid
SC008725Medicaid
SCH988953365Medicare PIN
SCP01221611OtherRAILROAD MEDICARE
SCH988953365OtherMEDICARE PIN