Provider Demographics
NPI:1174571863
Name:BARBARA A. KLATCHKO, M.D., LTD.
Entity type:Organization
Organization Name:BARBARA A. KLATCHKO, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLATCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-274-5440
Mailing Address - Street 1:402 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6617
Mailing Address - Country:US
Mailing Address - Phone:717-274-5200
Mailing Address - Fax:717-274-5440
Practice Address - Street 1:402 S 12TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6617
Practice Address - Country:US
Practice Address - Phone:717-274-5200
Practice Address - Fax:717-274-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044211E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01968502OtherBLUE CROSS
PA1519910OtherGATEWAY
P-42051920OtherMULTI-PLAN
4253876OtherAETNA
612189OtherBLUE SHIELD
PA0012789490004Medicaid
A0612189OtherHEALTH ONE
P-42051920OtherMULTI-PLAN
4253876OtherAETNA
PA1519910OtherGATEWAY
=========010OtherBC/BS UNITED OF WISCONSIN
612189OtherBLUE SHIELD