Healthcare Provider Details

I. General information

NPI: 1194959940
Provider Name (Legal Business Name): ERICA FAN CLAYTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA Y FAN M.D.

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

1615 HILL RD STE B
NOVATO CA
94947-4338
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7174
  • Fax: 415-898-0870
Mailing address:
  • Phone: 415-898-7649
  • Fax: 415-898-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMT195065
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT195065
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA130468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: