Provider Demographics
NPI:1518077767
Name:CLAYTON, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:1904 BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1403
Mailing Address - Country:US
Mailing Address - Phone:410-560-7975
Mailing Address - Fax:
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-825-3900
Practice Address - Fax:410-321-9404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDD036160207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2189Medicare ID - Type Unspecified
E83122Medicare UPIN