Provider Demographics
NPI:1407872807
Name:TOOTHMAN, CLARA JANE (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:JANE
Last Name:TOOTHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24294 TEAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-6160
Mailing Address - Country:US
Mailing Address - Phone:276-628-8303
Mailing Address - Fax:276-466-4815
Practice Address - Street 1:24294 TEAL DRIVE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-6160
Practice Address - Country:US
Practice Address - Phone:276-628-8303
Practice Address - Fax:276-466-4815
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010180023Medicaid
VA179147OtherBLUE CROSS
TN0101OtherJOHN DEERE
TN4107171OtherBLUE CROSS
P00228647OtherRR MEDICARE
TN0101OtherJOHN DEERE
VAC09538Medicare PIN
TN4107171OtherBLUE CROSS