Provider Demographics
NPI:1528229036
Name:KLINGLER, AMY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANN
Last Name:KLINGLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:SIMONEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6934 AVIATION BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2593
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-949-0825
Practice Address - Street 1:6934 AVIATION BLVD
Practice Address - Street 2:STE. B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2593
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:443-949-0825
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054860363AM0700X
MAAP2536363AM0700X
MDC0005017363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0006697Medicare PIN