Provider Demographics
NPI:1003870270
Name:ENG, CLIFFORD DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DOUGLAS
Last Name:ENG
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 1:5232 WESTPATH WAY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2261
Mailing Address - Country:US
Mailing Address - Phone:407-797-9032
Mailing Address - Fax:
Practice Address - Street 1:1314 SUMTER ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6385
Practice Address - Country:US
Practice Address - Phone:352-365-6877
Practice Address - Fax:352-323-8925
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88227207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48137OtherBCBS
FL48137OtherBCBS
FLH07635Medicare UPIN