Provider Demographics
NPI:1417533977
Name:KLONTZ, ERIK
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:KLONTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3725
Mailing Address - Country:US
Mailing Address - Phone:301-542-2362
Mailing Address - Fax:
Practice Address - Street 1:4703 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3725
Practice Address - Country:US
Practice Address - Phone:301-542-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program