Provider Demographics
NPI:1588644108
Name:KLINZING, GERARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:F
Last Name:KLINZING
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 1:933 E HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3819
Mailing Address - Country:US
Mailing Address - Phone:610-520-5200
Mailing Address - Fax:610-520-1998
Practice Address - Street 1:933 E HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3819
Practice Address - Country:US
Practice Address - Phone:610-520-5200
Practice Address - Fax:610-520-1998
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025267E207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35277Medicare UPIN
PA083755HK1Medicare PIN
PA232359401OtherMAIN LINE HEALTHCARE
B35277Medicare UPIN