Provider Demographics
NPI:1790812535
Name:CLAMAN, MARLA SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:SUSAN
Last Name:CLAMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1409
Mailing Address - Country:US
Mailing Address - Phone:610-506-3114
Mailing Address - Fax:215-426-7689
Practice Address - Street 1:31 LEOPARD RD
Practice Address - Street 2:PEARLE
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1517
Practice Address - Country:US
Practice Address - Phone:484-595-0345
Practice Address - Fax:215-426-7689
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA749763Medicare ID - Type Unspecified
PAU4722SMedicare UPIN