Provider Demographics
NPI:1407483266
Name:CLIATT, KENDALL ALEXANDER
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:ALEXANDER
Last Name:CLIATT
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 1:2705 DEKALB PIKE # 202
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1852
Mailing Address - Country:US
Mailing Address - Phone:610-275-7240
Mailing Address - Fax:610-275-0633
Practice Address - Street 1:2705 DEKALB PIKE # 202
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1852
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-0633
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS022851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program