Provider Demographics
NPI:1992786990
Name:KLUGE, CHARLES TAYLO (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:TAYLO
Last Name:KLUGE
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 1:532 BALTIMORE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6117
Mailing Address - Country:US
Mailing Address - Phone:410-751-8800
Mailing Address - Fax:410-751-9354
Practice Address - Street 1:532 BALTIMORE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6117
Practice Address - Country:US
Practice Address - Phone:410-751-8800
Practice Address - Fax:410-751-9354
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
K668G274Medicare ID - Type Unspecified
S59566Medicare UPIN