Provider Demographics
NPI:1114035995
Name:CLAYTOR, RICHARD BRANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRANNON
Last Name:CLAYTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:610-527-4803
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4437472086S0122X
ME0168642086S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431882299Medicaid
H22862Medicare UPIN
ME431882299Medicaid