Provider Demographics
NPI:1205975133
Name:KLEIN, ROBERT ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S VAN BUREN RD STE D
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5015
Mailing Address - Country:US
Mailing Address - Phone:336-627-4861
Mailing Address - Fax:336-623-4411
Practice Address - Street 1:519 S VAN BUREN RD STE D
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5015
Practice Address - Country:US
Practice Address - Phone:336-627-4861
Practice Address - Fax:336-623-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003574213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC163OtherNORTH CAROLINA LICENSE
NYN003574OtherNY LICENSE
NY00786769Medicaid
NYN003574OtherNY LICENSE
NY07783Medicare ID - Type UnspecifiedMEDICARE