Provider Demographics
NPI:1568451912
Name:DAHLEN, KJELL (MD)
Entity type:Individual
Prefix:DR
First Name:KJELL
Middle Name:
Last Name:DAHLEN
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 1:450 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1755
Mailing Address - Country:US
Mailing Address - Phone:518-566-2020
Mailing Address - Fax:518-561-5390
Practice Address - Street 1:450 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1755
Practice Address - Country:US
Practice Address - Phone:518-566-2020
Practice Address - Fax:518-561-5390
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY348981OtherEMPIRE BLUE CROSS
NY00493178Medicaid
107286OtherBC/UTICA
1343557OtherW/C
NY000405806007OtherBLUE SHIELD OF NE NY
134355OtherLICENSE
441181708OtherRAILROAD MC
179075OtherMVP SELECT CARE
179075OtherMVP SELECT CARE
134355OtherLICENSE
179075OtherMVP SELECT CARE
441181708OtherRAILROAD MC