Provider Demographics
NPI:1437266806
Name:CLUNE, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CLUNE
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 1:654 211TH ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1436
Mailing Address - Country:US
Mailing Address - Phone:410-360-0615
Mailing Address - Fax:
Practice Address - Street 1:1506 JOH AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1000
Practice Address - Country:US
Practice Address - Phone:410-242-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20052OtherLICENSE #