Provider Demographics
NPI:1659304921
Name:CLARION MEDICAL, LLC
Entity Type:Organization
Organization Name:CLARION MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GITIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-783-1122
Mailing Address - Street 1:515 SHOEMAKER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3599
Mailing Address - Country:US
Mailing Address - Phone:610-783-1122
Mailing Address - Fax:610-783-0737
Practice Address - Street 1:515 SHOEMAKER RD
Practice Address - Street 2:SUITE D
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3599
Practice Address - Country:US
Practice Address - Phone:610-783-1122
Practice Address - Fax:610-783-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015569960001Medicaid
PA1015569960001Medicaid