Healthcare Provider Details

I. General information

NPI: 1568825248
Provider Name (Legal Business Name): CLAYTON BRITTINGHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 07/03/2024
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY MEDICAL CENTER
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4090 RIVER FORTH DR
FAIRFAX VA
22030-8563
US

V. Phone/Fax

Practice location:
  • Phone: 410-603-6816
  • Fax:
Mailing address:
  • Phone: 860-235-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0102204951
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0102204951
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: