Provider Demographics
NPI:1427151711
Name:LEOPOLD, CLAYTON E (MD)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:E
Last Name:LEOPOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 COMMERCE PL
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1302
Practice Address - Country:US
Practice Address - Phone:732-499-0606
Practice Address - Fax:732-499-8128
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA039201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
013557Medicare ID - Type Unspecified
C57810Medicare UPIN