Provider Demographics
NPI:1467424846
Name:KLONEL, STEPHEN G (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:KLONEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PETERBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5860
Mailing Address - Country:US
Mailing Address - Phone:603-532-8775
Mailing Address - Fax:
Practice Address - Street 1:82 PETERBOROUGH ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-5860
Practice Address - Country:US
Practice Address - Phone:603-532-8775
Practice Address - Fax:603-532-7482
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30223741Medicaid
NH30223741Medicaid
NH30223741Medicaid