Provider Demographics
NPI:1952379570
Name:KLEINER, EDWARD H (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:H
Last Name:KLEINER
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 1:2025 GALISTEO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2101
Mailing Address - Country:US
Mailing Address - Phone:505-995-4901
Mailing Address - Fax:505-989-6426
Practice Address - Street 1:2025 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2101
Practice Address - Country:US
Practice Address - Phone:505-995-4901
Practice Address - Fax:505-989-6426
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00015297Medicaid
10008298OtherLOVELACE
5064209OtherCCN
PROVP13467OtherMOLINA
1699559OtherUHC
201005308OtherPRESBYTERIAN HEALTH PLANS
NMNM001515OtherBCBS NM
5064209OtherCCN
NM348412002Medicare PIN