Provider Demographics
NPI:1134613664
Name:CLAPP, MARIAH LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LYNN
Last Name:CLAPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19875 CENTER RIDGE RD APT 462
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3656
Mailing Address - Country:US
Mailing Address - Phone:419-953-7578
Mailing Address - Fax:
Practice Address - Street 1:25200 CENTER RIDGE RD STE 3300
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4145
Practice Address - Country:US
Practice Address - Phone:440-306-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005512RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty