Provider Demographics
NPI:1124047816
Name:KLUG, GERALD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:KLUG
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 1:109 PINE ACRES LN
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2968
Mailing Address - Country:US
Mailing Address - Phone:412-225-9054
Mailing Address - Fax:
Practice Address - Street 1:3528 BLVD OF THE ALLIES
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-4355
Practice Address - Country:US
Practice Address - Phone:412-681-1406
Practice Address - Fax:412-681-1408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032913-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010269410001Medicaid
PA077182Medicare ID - Type Unspecified
PAB35106Medicare UPIN