Provider Demographics
NPI:1053979351
Name:KLINGBEIL, MARTHA DIANE (DPM)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DIANE
Last Name:KLINGBEIL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 PLANK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8389
Mailing Address - Country:US
Mailing Address - Phone:814-696-3397
Mailing Address - Fax:814-696-9477
Practice Address - Street 1:1798 PLANK RD STE 201
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8389
Practice Address - Country:US
Practice Address - Phone:814-696-3397
Practice Address - Fax:814-696-9477
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC007012213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty