Provider Demographics
NPI:1053362301
Name:THALER, KLAUS (MD)
Entity type:Individual
Prefix:
First Name:KLAUS
Middle Name:
Last Name:THALER
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 1:30 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3859
Mailing Address - Country:US
Mailing Address - Phone:203-852-3379
Mailing Address - Fax:203-855-3878
Practice Address - Street 1:30 STEVENS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3859
Practice Address - Country:US
Practice Address - Phone:203-852-3379
Practice Address - Fax:203-855-3878
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050438208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035703Medicaid
CTD400182059Medicare PIN
CT008035703Medicaid
MOP00371832OtherRAILROAD MEDICARE
MOP00419183OtherRAILROAD MEDICARE
MO207277500Medicaid