Provider Demographics
NPI:1376552992
Name:KING, VICTORIA ANN KLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN KLINE
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 LANGTREE VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7594
Practice Address - Country:US
Practice Address - Phone:704-384-7101
Practice Address - Fax:704-384-7102
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904366Medicaid
I65506Medicare UPIN
NC2057220Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NC5904366Medicaid