Healthcare Provider Details

I. General information

NPI: 1730108994
Provider Name (Legal Business Name): CLEARFIELD PROFESSIONAL GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 TURNPIKE AVE
CLEARFIELD PA
16830-1229
US

IV. Provider business mailing address

820 TURNPIKE AVE
CLEARFIELD PA
16830-1229
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-2412
  • Fax: 814-765-8807
Mailing address:
  • Phone: 814-765-2412
  • Fax: 814-765-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN BLAIR WITHEROW
Title or Position: BUSINESS MANAGER
Credential:
Phone: 814-765-5796