Provider Demographics
NPI:1336216571
Name:DELASHAW, CLINTON LEE (MD)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:LEE
Last Name:DELASHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-621-4116
Mailing Address - Fax:207-622-4085
Practice Address - Street 1:35 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8160
Practice Address - Country:US
Practice Address - Phone:207-621-4116
Practice Address - Fax:207-622-4085
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME016405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME402660000Medicaid
ME022763OtherANTHEM
ME022763OtherANTHEM
ME402660000Medicaid