Provider Demographics
NPI:1255417812
Name:KLEGON, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KLEGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:463 WORCESTER RD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5356
Mailing Address - Country:US
Mailing Address - Phone:508-665-5900
Mailing Address - Fax:508-665-5902
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:SUITE 407
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5356
Practice Address - Country:US
Practice Address - Phone:508-665-5900
Practice Address - Fax:508-665-5902
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA567732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3021548Medicaid
A58910Medicare UPIN
MA3021548Medicaid