Provider Demographics
NPI:1609815703
Name:KLINGER, ANGELA JEAN (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:KLINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1244 STATE ROUTE 225
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:PA
Practice Address - Zip Code:17830-7324
Practice Address - Country:US
Practice Address - Phone:570-758-3511
Practice Address - Fax:570-758-4736
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010653L207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008438640001Medicaid
PA1008438640002Medicaid
PA071332F6KMedicare PIN