1881673986 NPI number — CLAYTON L RAAB MD

Table of content: CLAYTON L RAAB MD (NPI 1881673986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881673986 NPI number — CLAYTON L RAAB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAAB
Provider First Name:
CLAYTON
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881673986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3910 GOLD HAWK MEWS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-546-1402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3910 GOLD HAWK MEWS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-546-1402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  D0019289 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 319351900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010199336 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4404953 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 262255 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 343883 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P0022143 . This is a "MEDDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4696048 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10000022830 . This is a "DELAWARE PHY." identifier . This identifiers is of the category "OTHER".
  • Identifier: J333-0002 . This is a "BLUE CROSS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 000017371 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41953706 . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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