Provider Demographics
NPI:1124240387
Name:HEARD, CLAYTON LEMUEL (CSA)
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:LEMUEL
Last Name:HEARD
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5700 ALLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2310
Mailing Address - Country:US
Mailing Address - Phone:301-552-5912
Mailing Address - Fax:202-785-4787
Practice Address - Street 1:5700 ALLWOOD CT
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2310
Practice Address - Country:US
Practice Address - Phone:301-552-5912
Practice Address - Fax:202-785-4787
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2865246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist