Charles Clayton Jr., M.D.
Individual provider Active NPI Family Medicine Physician · Wyncote, PA
NPI 1437112265 · NPPES record last updated Feb 18, 2013
Key facts
- NPI
- 1437112265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD037419L (PA)
- Practice address
- 2827 W Cheltenham Ave
Wyncote, PA 19095-2931 - Phone
- (215) 884-8815
- Fax
- (215) 884-5550
- NPI assigned
- Apr 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD037419L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chestnut Hill Clinic Company, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD037419L | PA | Yes |
Addresses
Primary practice location
2827 W Cheltenham Ave
Wyncote, PA 19095-2931
Mailing address
2827 W Cheltenham Ave
Wyncote, PA 19095-2931
Phone (215) 884-8815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 093548 | Other | PA | BLUE CROSS/BLUE SHIELD |
| 0615552 | Medicaid | PA |
Other providers in Wyncote, PA
- James Stephen Chung
- Thomas John Cicippio III
- Antonia Clanton
- Clarity Acupuncture
- Beth Clarke
- Kyle Andrew Clayton
- Lacy Rae Clayton
- Melissa Lynn Clugston
- Ann L Colley
- Luis Antonio Colon
All providers in Wyncote, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.