Provider Demographics
NPI:1194235200
Name:STEVENSON, CLIFFORD GLENN
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:GLENN
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 PENNSRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3682
Mailing Address - Country:US
Mailing Address - Phone:610-909-1494
Mailing Address - Fax:
Practice Address - Street 1:328 CREST AVE
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-2641
Practice Address - Country:US
Practice Address - Phone:415-735-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study