Provider Demographics
NPI:1811996739
Name:STEVENSON, CLAYMON A II (DPM)
Entity type:Individual
Prefix:
First Name:CLAYMON
Middle Name:A
Last Name:STEVENSON
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ANNAPOLIS RD REAR 105
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3611
Mailing Address - Country:US
Mailing Address - Phone:410-439-9185
Mailing Address - Fax:410-355-4643
Practice Address - Street 1:4000 ANNAPOLIS RD REAR 105
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3611
Practice Address - Country:US
Practice Address - Phone:410-355-3519
Practice Address - Fax:410-355-4643
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24586213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U71560Medicare UPIN