Provider Demographics
NPI:1114022449
Name:CLAWSON, LANCE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:DOUGLAS
Last Name:CLAWSON
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-0000
Mailing Address - Country:US
Mailing Address - Phone:301-320-3700
Mailing Address - Fax:301-320-3742
Practice Address - Street 1:4701 SANGAMORE RD
Practice Address - Street 2:SUITE N252
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2508
Practice Address - Country:US
Practice Address - Phone:301-320-3700
Practice Address - Fax:301-320-3742
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00430452084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42822Medicare UPIN