Provider Demographics
NPI:1235383738
Name:KENNETH KLEIN
Entity Type:Organization
Organization Name:KENNETH KLEIN
Other - Org Name:EAST CAROLINA DERMATOLOGY AND SKIN SURGERY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-633-4200
Mailing Address - Street 1:600 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5231
Mailing Address - Country:US
Mailing Address - Phone:252-633-4200
Mailing Address - Fax:252-633-9263
Practice Address - Street 1:600 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5231
Practice Address - Country:US
Practice Address - Phone:252-633-4200
Practice Address - Fax:252-633-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8949680Medicaid
49680OtherBCBS
207N00000XOtherMEDICAID
2183602OtherMEDICARE
NCF38755OtherUPIN
NC1174507990OtherNPI