Provider Demographics
NPI:1770528648
Name:KLEIN, PAVEL (MD)
Entity type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:KLEIN
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 1:6410 ROCKLEDGE DRIVE, #610
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:UM
Mailing Address - Phone:301-530-9744
Mailing Address - Fax:301-530-0046
Practice Address - Street 1:6410 ROCKLEDGE DRIVE, #610
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:UM
Practice Address - Phone:301-530-9744
Practice Address - Fax:301-530-0046
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00542702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3117668OtherOPTIMUM CHOICE
521186611OtherUNITED HEALTH CARE
MD9070 0036OtherBSDC
3117668OtherALLIANCE
MD1453333OtherCIGNA PIN
MD687510-04OtherBSMD
MD3117668OtherMDIPA
MD311100801Medicaid
3117668OtherMAMSI
3117668OtherALLIANCE
MD687510-04OtherBSMD