Provider Demographics
NPI:1770503922
Name:CLEVENSON, DAVID JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOEL
Last Name:CLEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:24 GLOUCESTER ROAD
Practice Address - Street 2:UVA STUARTS DRAFT FAMILY PRACTICE
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477
Practice Address - Country:US
Practice Address - Phone:540-337-3710
Practice Address - Fax:540-967-0930
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101059122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005639018Medicaid
VAB86430Medicare UPIN
VA010489U92Medicare PIN