Provider Demographics
NPI:1255370417
Name:KLEIN, CAROL ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANGELA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2421
Mailing Address - Country:US
Mailing Address - Phone:304-523-1142
Mailing Address - Fax:304-523-2966
Practice Address - Street 1:1415 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2421
Practice Address - Country:US
Practice Address - Phone:304-523-1142
Practice Address - Fax:304-523-2966
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV165972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0115396000Medicaid
WVCA0743412Medicare ID - Type Unspecified
WV0115396000Medicaid
WVKL0743413Medicare ID - Type Unspecified