Provider Demographics
NPI:1114950862
Name:CLAWSON, KEVIN R (DO)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4501
Mailing Address - Country:US
Mailing Address - Phone:717-267-2065
Mailing Address - Fax:
Practice Address - Street 1:40 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4501
Practice Address - Country:US
Practice Address - Phone:717-267-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006834L174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1144982OtherAETNA
PA0012279400001Medicaid
PA1618858OtherBLUE SHIELD
630057U43Medicare ID - Type Unspecified
PA20717OtherHEALTHAMERICA
PAE76361Medicare UPIN
PA50058291OtherBLUE CROSS