Provider Demographics
NPI:1255478590
Name:KLETTI, NICHOLAS B (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
Last Name:KLETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 CONGRESS ST
Mailing Address - Street 2:C283
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04122-0002
Mailing Address - Country:US
Mailing Address - Phone:207-575-2129
Mailing Address - Fax:
Practice Address - Street 1:2211 CONGRESS ST
Practice Address - Street 2:C283
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04122-0002
Practice Address - Country:US
Practice Address - Phone:207-575-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA588622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry