Provider Demographics
NPI:1235176769
Name:CLEVINGER, ERNEST CLAUDE JR (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:CLAUDE
Last Name:CLEVINGER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:174 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4423
Mailing Address - Country:US
Mailing Address - Phone:301-668-9380
Mailing Address - Fax:301-668-9480
Practice Address - Street 1:174 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4423
Practice Address - Country:US
Practice Address - Phone:301-668-9380
Practice Address - Fax:301-668-9480
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD576472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD886503500Medicaid
MDH38850Medicare UPIN
161N150GMedicare PIN