Provider Demographics
NPI:1982601860
Name:KLEIN, STEVEN ALAN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:KLEIN
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 1:265 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1817
Mailing Address - Country:US
Mailing Address - Phone:800-258-4674
Mailing Address - Fax:508-897-3198
Practice Address - Street 1:265 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1817
Practice Address - Country:US
Practice Address - Phone:800-258-4674
Practice Address - Fax:508-897-3198
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1571422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0111848Medicaid
MAJ22570OtherBCBS
MAJ22570OtherBCBS
H04367Medicare UPIN