Provider Demographics
NPI:1124305156
Name:DAVID KLOTH MD PC
Entity type:Organization
Organization Name:DAVID KLOTH MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-792-5118
Mailing Address - Street 1:109 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4120
Mailing Address - Country:US
Mailing Address - Phone:203-792-5118
Mailing Address - Fax:203-792-9636
Practice Address - Street 1:109 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4120
Practice Address - Country:US
Practice Address - Phone:203-792-5118
Practice Address - Fax:203-792-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031511207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1336137058Medicare PIN