Provider Demographics
NPI:1205947868
Name:KLEIN, ROGER JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:JOHN
Last Name:KLEIN
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:613 23RD ST STE 230
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2868
Practice Address - Country:US
Practice Address - Phone:606-324-4745
Practice Address - Fax:606-324-4941
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23894207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01312545OtherRR MEDICARE
KYP00704455OtherMEDICARE-RAILROAD KY
OHP01428750OtherRR MEDICARE
OH0599606Medicaid
KY64238942Medicaid
WV0081444000Medicaid
KYP110081097OtherRR MEDICARE
OHP01428750OtherRR MEDICARE
C75272Medicare UPIN
KY00788022Medicare PIN
KYP00704455OtherMEDICARE-RAILROAD KY
OHH408400Medicare PIN