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General NPI Number Information
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NPI Number | 1619613890
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Entity Type | Organization
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Legal Business Name | CLEARALL AIT
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 5410 RITCHIE HWY STE A
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City | BROOKLYN PARK
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State | MD
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Zip | 21225-3069
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Country | US
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Telephone | 667-930-5999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 46
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City | TERRA CEIA
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State | FL
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Zip | 34250-0046
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Country | US
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Telephone | 667-930-5999
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | MR. ROBERT WILLIAM JACOBS JR.
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Credential |
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Telephone | 703-627-0879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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