Provider Demographics
NPI:1992813794
Name:CLOUSE, WAYNE E (DPM)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:CLOUSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 ROWAN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3616
Mailing Address - Country:US
Mailing Address - Phone:724-776-4577
Mailing Address - Fax:724-776-5226
Practice Address - Street 1:8001 ROWAN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-3617
Practice Address - Country:US
Practice Address - Phone:724-776-4577
Practice Address - Fax:724-776-5226
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002566L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA63652OtherHIGHMARK
PA455380Medicare ID - Type Unspecified
PA63652OtherHIGHMARK