Provider Demographics
NPI:1336230416
Name:CLOSSON, CAREY-WALTER FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREY-WALTER
Middle Name:FRANKLIN
Last Name:CLOSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-464-7008
Mailing Address - Fax:301-464-7011
Practice Address - Street 1:16900 SCIENCE DR
Practice Address - Street 2:STE100
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4401
Practice Address - Country:US
Practice Address - Phone:301-464-7008
Practice Address - Fax:301-464-7011
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059643208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336423200Medicaid
MD336423200Medicaid
DC249056ZB0UMedicare PIN
MD402058800Medicaid
MDH86866Medicare UPIN
MDG479Medicare PIN