Healthcare Provider Details

I. General information

NPI: 1558822395
Provider Name (Legal Business Name): JOSEPH WILLIAM CLINTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 410
LAUREL MD
20707-5265
US

IV. Provider business mailing address

7350 VAN DUSEN RD STE 410
LAUREL MD
20707-5265
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-5500
  • Fax: 301-498-7346
Mailing address:
  • Phone: 301-498-5500
  • Fax: 301-498-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0101175
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: