Provider Demographics
NPI:1629159066
Name:CLAYTON W STRAUGHN MD PA
Entity Type:Organization
Organization Name:CLAYTON W STRAUGHN MD PA
Other - Org Name:COMPREHENSIVE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:WILBERT
Authorized Official - Last Name:STRAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-260-0230
Mailing Address - Street 1:4404 QUEENSBURY RD STE 130
Mailing Address - Street 2:COMPREHENSIVE FAMILY MEDICAL CENTER
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737
Mailing Address - Country:US
Mailing Address - Phone:240-260-0230
Mailing Address - Fax:240-260-0219
Practice Address - Street 1:4404 QUEENSBURY RD STE 130
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1068
Practice Address - Country:US
Practice Address - Phone:240-260-0230
Practice Address - Fax:240-260-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45796261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00821Medicare UPIN