Healthcare Provider Details

I. General information

NPI: 1447631536
Provider Name (Legal Business Name): CLINTON ALEXANDER VESELIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6301
  • Fax: 570-271-5976
Mailing address:
  • Phone: 570-271-6301
  • Fax: 570-271-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD477255
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD477255
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: