Provider Demographics
NPI:1740340587
Name:KLOSS, BRIAN T (DO, PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:KLOSS
Suffix:
Gender:M
Credentials:DO, PA-C
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:UNIVERSITY HOSPITAL - DEPT EMERGENCY MEDICINE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-4363
Practice Address - Fax:315-464-8690
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010006363A00000X
NY260037-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02982474Medicaid
NYJ400049908Medicare PIN