Healthcare Provider Details

I. General information

NPI: 1811996739
Provider Name (Legal Business Name): CLAYMON A STEVENSON II DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ANNAPOLIS RD REAR 105
HALETHORPE MD
21227-3611
US

IV. Provider business mailing address

4000 ANNAPOLIS RD REAR 105
HALETHORPE MD
21227-3611
US

V. Phone/Fax

Practice location:
  • Phone: 410-355-3519
  • Fax: 410-355-4643
Mailing address:
  • Phone: 410-439-9185
  • Fax: 410-355-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number24586
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: