Provider Demographics
NPI:1912240904
Name:CLIFTON, CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SCHILLING RD STE C
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1191
Mailing Address - Country:US
Mailing Address - Phone:410-771-9220
Mailing Address - Fax:410-771-9301
Practice Address - Street 1:9 SCHILLING RD STE 102
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-8611
Practice Address - Country:US
Practice Address - Phone:410-771-9220
Practice Address - Fax:410-771-9301
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018289207Q00000X
MDH0095584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103131896Medicaid
MDH0095584Medicaid