Healthcare Provider Details

I. General information

NPI: 1942134499
Provider Name (Legal Business Name): CLINICAL ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SOUTHERLY RD STE 100G
TOWSON MD
21286-8403
US

IV. Provider business mailing address

515 FAIRMOUNT AVE STE 400
BALTIMORE MD
21286-8518
US

V. Phone/Fax

Practice location:
  • Phone: 410-339-6174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JEWEL WATSON
Title or Position: CRED COORD
Credential:
Phone: 410-494-1237