Provider Demographics
NPI:1902824378
Name:KLINE, RICHARD BLAKE (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BLAKE
Last Name:KLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 CULTRA RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3716
Mailing Address - Country:US
Mailing Address - Phone:843-438-8470
Mailing Address - Fax:843-438-8480
Practice Address - Street 1:2767 CULTRA RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3716
Practice Address - Country:US
Practice Address - Phone:843-438-8470
Practice Address - Fax:843-438-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20364207LP2900X, 207L00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203648Medicaid
SCG21460Medicare UPIN
SCG214607234Medicare PIN
SC050084909Medicare PIN
G21460Medicare UPIN
SC203648Medicaid