Provider Demographics
NPI:1992805188
Name:KLONOSKI, RICHARD F (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:KLONOSKI
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 1:82 GAMAGE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4723
Mailing Address - Country:US
Mailing Address - Phone:207-344-8632
Mailing Address - Fax:
Practice Address - Street 1:82 GAMAGE AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4723
Practice Address - Country:US
Practice Address - Phone:207-344-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36642207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85862Medicare UPIN