Provider Demographics
NPI:1083010243
Name:CLAYTOR PLASTIC SURGERY, INC
Entity Type:Organization
Organization Name:CLAYTOR PLASTIC SURGERY, INC
Other - Org Name:CLAYTOR NOONE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:BRANNON
Authorized Official - Last Name:CLAYTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:610-527-4833
Mailing Address - Street 1:135 S BRYN MAWR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3131
Mailing Address - Country:US
Mailing Address - Phone:610-527-4833
Mailing Address - Fax:610-527-7403
Practice Address - Street 1:135 S BRYN MAWR AVE STE 300
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3131
Practice Address - Country:US
Practice Address - Phone:610-527-4833
Practice Address - Fax:610-527-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443747208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty