Provider Demographics
NPI:1497765564
Name:CLOUGH, DOUGLAS FRANK (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANK
Last Name:CLOUGH
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 1:9401 MCKNIGHT ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6000
Mailing Address - Country:US
Mailing Address - Phone:412-366-7070
Mailing Address - Fax:412-369-8355
Practice Address - Street 1:9401 MCKNIGHT ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6000
Practice Address - Country:US
Practice Address - Phone:412-366-7070
Practice Address - Fax:412-369-8355
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016510E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00066844900300003Medicaid
C27691Medicare UPIN
PA00066844900300003Medicaid