MEDICARE: ANDREA CLAYTOR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.002919	OH

General Provider Information

NPI Number	:	1306077987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CLAYTOR PA-C

Provider Business Mailing Address
First Line	:	1100 SUNBURY RD
Second Line	:	#706
City	:	DELAWARE
State	:	OH
Zip	:	43015-6040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SUNBURY RD
Second Line	:	#706
City	:	DELAWARE
State	:	OH
Zip	:	43015-6040
Country	:	US
Telephone Number	:	740-363-3133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	09/25/2013

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