Provider Demographics
NPI:1750434791
Name:KLINGEN, DONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:KLINGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:599 ARCOLA RD
Mailing Address - Street 2:MAIN LINE HEALTH CENTER
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3954
Mailing Address - Country:US
Mailing Address - Phone:484-565-8440
Mailing Address - Fax:610-409-6160
Practice Address - Street 1:599 ARCOLA RD
Practice Address - Street 2:MAIN LINE HEALTH CENTER
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3954
Practice Address - Country:US
Practice Address - Phone:484-565-8440
Practice Address - Fax:610-409-6160
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD074108L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH56250Medicare UPIN
PA055704HK1Medicare PIN
PA001864104Medicaid