Provider Demographics
NPI:1427405497
Name:UMSTEAD, CLIFTON (DO)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
Last Name:UMSTEAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17855 STATE ROUTE 821
Mailing Address - Street 2:
Mailing Address - City:MACKSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45746-7502
Mailing Address - Country:US
Mailing Address - Phone:631-819-2396
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-374-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292574207Q00000X
OH34.015728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine