Provider Demographics
NPI:1710189444
Name:CLAY, STEPHEN NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NATHANIEL
Last Name:CLAY
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 1:1835 PEMBERTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1823
Mailing Address - Country:US
Mailing Address - Phone:610-574-0922
Mailing Address - Fax:
Practice Address - Street 1:1306 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3213
Practice Address - Country:US
Practice Address - Phone:215-238-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-045386-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine