Healthcare Provider Details

I. General information

NPI: 1619613890
Provider Name (Legal Business Name): CLEARALL AIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 RITCHIE HWY STE A
BROOKLYN PARK MD
21225-3069
US

IV. Provider business mailing address

PO BOX 46
TERRA CEIA FL
34250-0046
US

V. Phone/Fax

Practice location:
  • Phone: 667-930-5999
  • Fax:
Mailing address:
  • Phone: 667-930-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT WILLIAM JACOBS JR.
Title or Position: CO-FOUNDER
Credential:
Phone: 703-627-0879