Provider Demographics
NPI:1932113099
Name:KLIGMAN, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:KLIGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64226
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4742
Mailing Address - Country:US
Mailing Address - Phone:410-328-6897
Mailing Address - Fax:410-328-2109
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6897
Practice Address - Fax:410-328-2109
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID0037195208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1703372OtherUNITED HLTHCARE
MD2504277OtherUNITED HLTHCARE REGIONAL
MD0100OtherCAREFIRST REGIONAL
MD2127854OtherMDIPA
MD91104OtherGEISINGER
MD42625701OtherBLUE SHIELD
MD2504277OtherUNITED HLTHCARE REGIONAL
MD1703372OtherUNITED HLTHCARE