Provider Demographics
NPI:1831942127
Name:CLEARALL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CLEARALL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-328-9217
Mailing Address - Street 1:7500 MONTPELIER RD
Mailing Address - Street 2:STE 150 MAI STOP 370
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6012
Mailing Address - Country:US
Mailing Address - Phone:888-231-8207
Mailing Address - Fax:
Practice Address - Street 1:907 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2273
Practice Address - Country:US
Practice Address - Phone:888-231-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARALL PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774026300Medicaid