Provider Demographics
NPI:1619613890
Name:CLEARALL AIT
Entity Type:Organization
Organization Name:CLEARALL AIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:703-627-0879
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0046
Mailing Address - Country:US
Mailing Address - Phone:667-930-5999
Mailing Address - Fax:
Practice Address - Street 1:5410 RITCHIE HWY STE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3069
Practice Address - Country:US
Practice Address - Phone:667-930-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD987202700Medicaid