Provider Demographics
NPI:1114917895
Name:CLAWSON, TERESA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:CLAWSON
Suffix:
Gender:F
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 1910
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-8060
Mailing Address - Country:US
Mailing Address - Phone:866-878-4221
Mailing Address - Fax:540-536-4359
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:STE 4C
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-7897
Practice Address - Fax:540-536-7843
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010539092080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0110415000Medicaid
541855193OtherCHIR
PA1881983Medicaid
MD400188500Medicaid
541855193OtherMAMSI
IN200509800Medicaid
541855193OtherACORDIA
231639OtherBS TRIGON
VA006718442Medicaid
VA231639OtherANTHEM BC/BS
541855193OtherCHAMPUS
120591OtherSOUTHERN HEALTH
541855193OtherGWHC