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General NPI Number Information
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NPI Number | 1518256874
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Entity Type | Individual
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Provider Name | KAVAN T CLIFFORD M.D./ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 733 N BROADWAY OFFICE OF THE REGISTRAR, BRB SUITE 147
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City | BALTIMORE
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State | MD
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Zip | 21205-1832
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Country | US
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Telephone | 410-614-3301
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Fax | 410-955-0826
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Provider Business Mailing Address
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Address Line | 733 N BROADWAY OFFICE OF THE REGISTRAR, BRB SUITE 147
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City | BALTIMORE
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State | MD
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Zip | 21205-1832
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Country | US
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Telephone | 410-614-3301
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Fax | 410-955-0826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D79536
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License Number State | MD
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