Provider Demographics
NPI:1023098514
Name:AMOS, CLIFFORD (PA)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HARRY S TRUMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7601
Mailing Address - Country:US
Mailing Address - Phone:410-897-0272
Mailing Address - Fax:410-897-1968
Practice Address - Street 1:200 HARRY S TRUMAN PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7601
Practice Address - Country:US
Practice Address - Phone:410-897-0272
Practice Address - Fax:410-897-1968
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102426363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1736VOtherBCBS
MD887475100Medicaid
NC8102548Medicaid
NC2746104AMedicare PIN