Provider Demographics
NPI:1104874932
Name:KLATCHKO, BARBARA A (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:KLATCHKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 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
Is Sole Proprietor?:No
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?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1519910OtherGATEWAY
A0612189OtherHEALTHONE
P-42051920OtherMULTI-PLAN
PA0012789490004Medicaid
612189OtherBLUE SHIELD
233096442010OtherBC/BS UNITED OF WISCONSIN
01968502OtherBLUE CROSS
4253876OtherAETNA
233096442010OtherBC/BS UNITED OF WISCONSIN
P-42051920OtherMULTI-PLAN
PAE15610Medicare UPIN
A0612189OtherHEALTHONE