1114917895 NPI number — DR. TERESA L CLAWSON MD

Table of content: DR. TERESA L CLAWSON MD (NPI 1114917895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114917895 NPI number — DR. TERESA L CLAWSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAWSON
Provider First Name:
TERESA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1114917895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22604-8060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-878-4221
Provider Business Mailing Address Fax Number:
540-536-4359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 AMHERST ST
Provider Second Line Business Practice Location Address:
STE 4C
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-536-7897
Provider Business Practice Location Address Fax Number:
540-536-7843
Provider Enumeration Date:
10/25/2005

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: 2080N0001X , with the licence number:  0101053909 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0110415000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541855193 . This is a "CHIR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881983 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400188500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541855193 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200509800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541855193 . This is a "ACORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 231639 . This is a "BS TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006718442 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231639 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541855193 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120591 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541855193 . This is a "GWHC" identifier . This identifiers is of the category "OTHER".




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