Provider Demographics
NPI:1609984715
Name:KLOSTERMAN, KAMERON BURKE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMERON
Middle Name:BURKE
Last Name:KLOSTERMAN
Suffix:
Gender:F
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:7221 S PINE ST
Practice Address - Street 2:
Practice Address - City:PACOLET
Practice Address - State:SC
Practice Address - Zip Code:29372-3122
Practice Address - Country:US
Practice Address - Phone:864-474-1528
Practice Address - Fax:864-474-1049
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC270236Medicaid
SCP01221611OtherRAIRLROAD MEDICARE
SCSC9525J577OtherMEDICARE PIN
SC9997050OtherAETNA
SCP01221611OtherRAIRLROAD MEDICARE
SCSC95253365Medicare PIN
SCAA08145193Medicare PIN
SCAA08146084Medicare PIN
SCAA0814Medicare PIN