Provider Demographics
NPI:1992875488
Name:STRAUGHN, CLAYTON W (MD)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:W
Last Name:STRAUGHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4404 QUEENSBURY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1068
Mailing Address - Country:US
Mailing Address - Phone:240-260-0230
Mailing Address - Fax:240-260-0219
Practice Address - Street 1:4404 QUEENSBURY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1068
Practice Address - Country:US
Practice Address - Phone:240-260-0230
Practice Address - Fax:240-260-0219
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0045796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD310501600Medicaid
MD270043232OtherTAX ID
DCG622OtherCAREFIRST
MD310501600Medicaid
G00821Medicare UPIN