Provider Demographics
NPI:1124136353
Name:KLAUS, MELISSA MAE (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MAE
Last Name:KLAUS
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 1:379 NAUBUC AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-652-3320
Mailing Address - Fax:
Practice Address - Street 1:379 NAUBUC AVENUE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-652-3320
Practice Address - Fax:860-657-3116
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE70862Medicare UPIN