Provider Demographics
NPI:1376633610
Name:CLAYTOR, RICHARD LAMONT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAMONT
Last Name:CLAYTOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-6390
Mailing Address - Country:US
Mailing Address - Phone:540-483-0373
Mailing Address - Fax:877-803-9136
Practice Address - Street 1:1625 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6390
Practice Address - Country:US
Practice Address - Phone:540-483-0373
Practice Address - Fax:877-803-9136
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010557272084P0804X, 2084P0800X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010028086Medicaid
G52382Medicare UPIN