Provider Demographics
NPI:1265704472
Name:KLATSKY, ALAN USHER (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:USHER
Last Name:KLATSKY
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 1:25 CASSANDRA BLVD
Mailing Address - Street 2:102
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3144
Mailing Address - Country:US
Mailing Address - Phone:860-561-8501
Mailing Address - Fax:
Practice Address - Street 1:25 CASSANDRA BLVD
Practice Address - Street 2:APARTMENT102
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3144
Practice Address - Country:US
Practice Address - Phone:860-561-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine