Healthcare Provider Details

I. General information

NPI: 1083010243
Provider Name (Legal Business Name): CLAYTOR PLASTIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S BRYN MAWR AVE STE 300
BRYN MAWR PA
19010-3131
US

IV. Provider business mailing address

135 S BRYN MAWR AVE STE 300
BRYN MAWR PA
19010-3131
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-4833
  • Fax: 610-527-7403
Mailing address:
  • Phone: 610-527-4833
  • Fax: 610-527-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD443747
License Number StatePA

VIII. Authorized Official

Name: DR. R. BRANNON CLAYTOR
Title or Position: OWNER
Credential: MD, FACS
Phone: 610-527-4833