Provider Demographics
NPI:1417998949
Name:CLAYTON, BARTHOLOMEW (MD)
Entity Type:Individual
Prefix:DR
First Name:BARTHOLOMEW
Middle Name:
Last Name:CLAYTON
Suffix:
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 1:45 HERRICK RD
Mailing Address - Street 2:SOUTWEST HARBOR MEDICAL CENTER
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-4433
Mailing Address - Country:US
Mailing Address - Phone:207-244-5513
Mailing Address - Fax:207-244-5515
Practice Address - Street 1:45 HERRICK RD
Practice Address - Street 2:SOUTWEST HARBOR MEDICAL CENTER
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4433
Practice Address - Country:US
Practice Address - Phone:207-244-5513
Practice Address - Fax:207-244-5515
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM3920Medicare PIN
MEMM392001Medicare PIN
MEF01174Medicare UPIN
MESX3741Medicare PIN