Provider Demographics
NPI:1790532323
Name:CLEARSCREEN LLC
Entity type:Organization
Organization Name:CLEARSCREEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-374-8188
Mailing Address - Street 1:1443 ROCK SPRING RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-1920
Mailing Address - Country:US
Mailing Address - Phone:443-374-8188
Mailing Address - Fax:410-297-0234
Practice Address - Street 1:1160 E NORTHERN PKWY # 116
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-1933
Practice Address - Country:US
Practice Address - Phone:443-374-8188
Practice Address - Fax:410-297-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty