Provider Demographics
NPI:1700848090
Name:KLINE, ROBERTA L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:KLINE
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 1:360 TOLLAND TPKE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1771
Mailing Address - Country:US
Mailing Address - Phone:860-646-1157
Mailing Address - Fax:860-646-9877
Practice Address - Street 1:360 TOLLAND TPKE
Practice Address - Street 2:SUITE 3B
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1771
Practice Address - Country:US
Practice Address - Phone:860-646-1157
Practice Address - Fax:860-646-9877
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT036776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001367764Medicaid
CT160001786Medicare ID - Type Unspecified
CT001367764Medicaid