Individual provider Active NPI

Roberta L. Kline, M.D.

  • Obstetrics & Gynecology Physician
  • Manchester, CT
National Provider Identifier
1700848090
Registry record updated Aug 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036776 Issued in CT
Practice address
360 Tolland Tpke
Suite 3B
Manchester, CT 06042-1771
Phone
(860) 646-1157
Fax
(860) 646-9877
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036776 CT Primary

Addresses

Primary practice location

360 Tolland Tpke
Suite 3B
Manchester, CT 06042-1771

Mailing address

360 Tolland Tpke
Suite 3B
Manchester, CT 06042-1771
Phone (860) 646-1157

Other identifiers 1

IdentifierTypeStateIssuer
001367764MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170504000482 NM Order and Referring Only - Obstetrics/GynecologyPractitioner - Obstetrics/Gynecology 2860380466

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036776CTMDObstetrics & Gynecology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251158400000",
    "number": "1700848090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 TOLLAND TPKE",
            "address_2": "SUITE 3B",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060421771",
            "telephone_number": "860-646-1157",
            "fax_number": "860-646-9877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 TOLLAND TPKE",
            "address_2": "SUITE 3B",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060421771",
            "telephone_number": "860-646-1157",
            "fax_number": "860-646-9877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLINE",
        "first_name": "ROBERTA",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2009-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "036776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001367764",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.