Healthcare Provider Details

I. General information

NPI: 1336520402
Provider Name (Legal Business Name): CLIFTON PETER THORNTON CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST RM 11356
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST RM 11356
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20150248
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: