MEDICARE: DR. STEPHEN NATHANIEL CLAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD-045386-L	PA

General Provider Information

NPI Number	:	1710189444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN NATHANIEL CLAY MD

Provider Business Mailing Address
First Line	:	1835 PEMBERTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1823
Country	:	US
Telephone Number	:	610-574-0922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3213
Country	:	US
Telephone Number	:	215-238-2163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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