Provider Demographics
NPI:1902179229
Name:CLARHAUT-MAYLOTT, JACQUELINE CECILIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:CECILIA
Last Name:CLARHAUT-MAYLOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:CECILIA
Other - Last Name:CLARHAUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:668 BETHLEHEM PIKE STE 4
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9711
Mailing Address - Country:US
Mailing Address - Phone:215-361-4423
Mailing Address - Fax:215-361-4424
Practice Address - Street 1:668 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9711
Practice Address - Country:US
Practice Address - Phone:215-361-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002712363A00000X
PAMA055071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant