Provider Demographics
NPI:1841260270
Name:KLUGO-FETTING, ANNE (PA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KLUGO-FETTING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LADY DIANA DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1096
Mailing Address - Country:US
Mailing Address - Phone:610-910-4087
Mailing Address - Fax:
Practice Address - Street 1:631 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3438
Practice Address - Country:US
Practice Address - Phone:704-864-7764
Practice Address - Fax:704-867-7894
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052599363A00000X
NC0010-08558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP2258Medicare ID - Type Unspecified
Q25331Medicare UPIN