Provider Demographics
NPI:1720070444
Name:KLOSSNER, ARTHUR W (PA)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:W
Last Name:KLOSSNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3308
Mailing Address - Country:US
Mailing Address - Phone:802-656-3350
Mailing Address - Fax:802-656-8178
Practice Address - Street 1:425 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3308
Practice Address - Country:US
Practice Address - Phone:802-656-3350
Practice Address - Fax:802-656-8178
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP66935Medicare UPIN
AP1793Medicare ID - Type Unspecified