Provider Demographics
NPI:1669535068
Name:KLETTER, JAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:C
Last Name:KLETTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9202
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:203 E 4TH AVE STE C
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1617
Practice Address - Country:US
Practice Address - Phone:304-725-6343
Practice Address - Fax:304-725-8808
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20334208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2000033000Medicaid
WV2000033000Medicaid
WVWV2345B987Medicare PIN