Provider Demographics
NPI:1891898433
Name:KLINE, PRUDENCE (MD PLLC)
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:MD PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 HALL PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1837
Mailing Address - Country:US
Mailing Address - Phone:202-494-1490
Mailing Address - Fax:
Practice Address - Street 1:2300 M ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1434
Practice Address - Country:US
Practice Address - Phone:202-741-2222
Practice Address - Fax:202-677-6995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC11864207R00000X
DCMD11864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010493800Medicaid
DCG00875Medicare PIN
DCC62647Medicare UPIN