Healthcare Provider Details

I. General information

NPI: 1427184332
Provider Name (Legal Business Name): TEODORA-ROWENA B CLANOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-6400
  • Fax:
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD039834
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD57745
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101230615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: