Provider Demographics
NPI:1023135175
Name:CLAYTON, THOMAS STANFORD IV (PA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STANFORD
Last Name:CLAYTON
Suffix:IV
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CLAYTONS WAY
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1836
Mailing Address - Country:US
Mailing Address - Phone:207-438-9893
Mailing Address - Fax:
Practice Address - Street 1:117 NORTH RD
Practice Address - Street 2:OCCUPATIONAL HEALTH SERVICES
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-6624
Practice Address - Country:US
Practice Address - Phone:603-679-5335
Practice Address - Fax:603-679-9329
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0126P363A00000X
MEPA-573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant