Provider Demographics
NPI:1275256984
Name:COLE, CLAYTON MICHAEL
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:MICHAEL
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAWTHORN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2028
Mailing Address - Country:US
Mailing Address - Phone:240-753-4490
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 960
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4315
Practice Address - Country:US
Practice Address - Phone:443-414-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program