Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD423158 | PA |
N | 207R00000X | Internist | MD423158 | PA |
N | 111NI0900X | Internist | MD423158 | PA |
NPI | 1003854753 |
---|---|
Provider Name | Dr. Clifford C Cloonan |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Mechanicsburg, PA 17050-2377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 26/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100920847 | (05) | PA |
D03358 | (02) |