=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114022449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LANCE DOUGLAS CLAWSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 07/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4701 SANGAMORE RD SUITE N252
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20816-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-320-3700
-----------------------------------------------------
Fax | 301-320-3742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9
-----------------------------------------------------
City | CABIN JOHN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20818-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-320-3700
-----------------------------------------------------
Fax | 301-320-3742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | D0043045
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | D0043045
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------