Provider Demographics
NPI:1417949918
Name:KLEINERT, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:KLEINERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GOLD STAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2738
Mailing Address - Country:US
Mailing Address - Phone:508-856-9599
Mailing Address - Fax:508-854-4997
Practice Address - Street 1:100 FRONT ST
Practice Address - Street 2:12TH FL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1425
Practice Address - Country:US
Practice Address - Phone:508-368-5510
Practice Address - Fax:508-368-5530
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022472E207W00000X
MA232530207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000934840Medicaid
B41876Medicare UPIN
442380Medicare ID - Type Unspecified