Healthcare Provider Details

I. General information

NPI: 1114035995
Provider Name (Legal Business Name): RICHARD BRANNON CLAYTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
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: 610-527-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number016864
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number016864
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD443747
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: