Provider Demographics
NPI:1770539728
Name:KLITZKE, MARGARET G (DO)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:G
Last Name:KLITZKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-432-1284
Mailing Address - Fax:401-432-1509
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1168
Practice Address - Fax:401-432-1500
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO003792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30150-1OtherBLUE CROSS
RI406278OtherBLUE CHIP
RI15-30886OtherUNITED BEHAVIORAL HEALTH
RI9006553Medicaid
RI15-30886OtherUNITED BEHAVIORAL HEALTH