Klocke, Mark R

Klocke, Mark R is an individual health care provider with primary practice located at 6000 N Bailey Ave , Amherst NY 14226-5102. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Klocke, Mark R can be contacted via phone (716) 834-4522.

Contact Information

Primary practice address
6000 N Bailey Ave Amherst NY 14226-5102
Phone: (716) 834-4522
Fax: (716) 834-6191
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 182253 New York

Profile Details

NPI number 1104816065
LBN Legal business name Klocke, Mark R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Jul 21st, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104816065 NPPES
New York Other 040426001490 FIDELIS
New York Other 00010092105 FIDELIS
New York MEDICAID 01245578 FIDELIS
New York Other 000511134005 FIDELIS
New York Other 1208952 FIDELIS
New York Other 143849DL FIDELIS

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