Provider Demographics
NPI:1780649426
Name:CLAYTON, SAMUEL T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:CLAYTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3320 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1023
Mailing Address - Country:US
Mailing Address - Phone:717-652-3881
Mailing Address - Fax:717-541-0317
Practice Address - Street 1:3320 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1023
Practice Address - Country:US
Practice Address - Phone:717-652-3881
Practice Address - Fax:717-541-0317
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017322E207Q00000X, 207R00000X, 208D00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01625201OtherCAPITAL BLUE CROSS ID
PAFC2258261OtherDEA NUMBER
PA01625201OtherCAPITAL BLUE CROSS ID