Provider Demographics
NPI:1952354680
Name:KLOSTER, NELS ANDREAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NELS
Middle Name:ANDREAS
Last Name:KLOSTER
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:PO BOX 4612
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-4612
Mailing Address - Country:US
Mailing Address - Phone:802-681-7955
Mailing Address - Fax:802-440-9805
Practice Address - Street 1:601 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-681-7955
Practice Address - Fax:802-440-9805
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00109832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTKL-VN3745Medicaid
VT1011737Medicaid
VT1011737Medicaid