Provider Demographics
NPI:1578617825
Name:CLAYBOUR, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CLAYBOUR
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 1:3535 NEWLAND RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:849 FAIRMONT AVENUE
Practice Address - Street 2:SUITE 100A
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2600
Practice Address - Country:US
Practice Address - Phone:410-494-1369
Practice Address - Fax:410-494-2737
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067501208000000X
MDP20038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics