Provider Demographics
NPI:1881852606
Name:KLEIN, CONRAD N
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:N
Last Name:KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15447 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-9782
Mailing Address - Country:US
Mailing Address - Phone:330-990-7029
Mailing Address - Fax:
Practice Address - Street 1:15447 CLINTON RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-9782
Practice Address - Country:US
Practice Address - Phone:330-990-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2808199Medicaid