Provider Demographics
NPI:1730283276
Name:KLUMPAR, DAVID IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IVAN
Last Name:KLUMPAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 FOX HOLLOW ROAD
Mailing Address - Street 2:STE 210
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8511
Mailing Address - Country:US
Mailing Address - Phone:910-295-7546
Mailing Address - Fax:910-692-2831
Practice Address - Street 1:125 FOX HOLLOW ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-295-7546
Practice Address - Fax:910-692-2831
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34653207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8949708Medicaid
NC0153YOtherBLUE CROSS BLUE SHIELD
NCCE7551OtherRAILROAD MEDICARE
NCCE7551OtherRAILROAD MEDICARE
G33351Medicare UPIN