Provider Demographics
NPI:1942265111
Name:KLINK, PAUL L (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:KLINK
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 1:1850 E PARK AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-689-3156
Mailing Address - Fax:814-689-1954
Practice Address - Street 1:1850 E PARK AVE STE 312
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-689-3156
Practice Address - Fax:814-689-1954
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043830-E207Q00000X
PAMD043830E207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6537219OtherAETNA HMO
PA80112334OtherRAILROAD MEDICARE
PA4329195OtherAETNA NON HMO
PA6537223OtherAETNA HMO
PA000162550OtherHIGHMARK BLUE SHIELD
PA001159750Medicaid
PA162550FSCMedicare PIN
PA162550LN7Medicare PIN
PA80112334OtherRAILROAD MEDICARE
PA80112334OtherRAILROAD MEDICARE