Provider Demographics
NPI:1891786588
Name:KLUNK, L. JOHN (MD)
Entity type:Individual
Prefix:
First Name:L. JOHN
Middle Name:
Last Name:KLUNK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:KLUNK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15 FREETOWN RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-2358
Mailing Address - Country:US
Mailing Address - Phone:603-895-8000
Mailing Address - Fax:603-895-8099
Practice Address - Street 1:15 FREETOWN RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2358
Practice Address - Country:US
Practice Address - Phone:603-895-8000
Practice Address - Fax:603-895-8099
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11322207R00000X
NH11300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201705Medicaid
NH0405788OtherUHC PIN
NH2626928OtherAETNA PIN
NHH48691OtherANTHEM REFERRING UPIN
NH011322OtherTUFTS PIN
NH990015596OtherRR MEDICARE PIN
NH01YP03386NH01OtherANTHEM ACES PIN
NH437891OtherCIGNA PIN
NHNH2255OtherHPHC PIN
NHNH2255OtherHPHC PIN
NH30201705Medicaid