Provider Demographics
NPI:1790785012
Name:CLAYDON, CRISANTA SAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISANTA
Middle Name:SAGE
Last Name:CLAYDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:200 BOWMAN DR STE E325A
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9623
Practice Address - Country:US
Practice Address - Phone:856-247-7420
Practice Address - Fax:856-247-7421
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417625207VF0040X, 207VF0040X
NJ25MA07298300207VF0040X
VA0101246704207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH58786Medicare UPIN
NC89085UUMedicaid
VAC06115OtherGROUP PTAN
NC085UUOtherBCBS NC
VAC06695OtherGROUP PTAN
NCP00378423OtherRAILROAD MEDICARE
NCH58786Medicare UPIN