Provider Demographics
NPI:1679113054
Name:DAWSON, CLIFTON III (CRNP)
Entity type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:
Last Name:DAWSON
Suffix:III
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10821 RED RUN BLVD UNIT 191
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-8520
Mailing Address - Country:US
Mailing Address - Phone:443-204-6096
Mailing Address - Fax:
Practice Address - Street 1:110 PAINTERS MILL RD STE 206
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5251
Practice Address - Country:US
Practice Address - Phone:443-204-6096
Practice Address - Fax:443-234-9336
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149435363LA2200X, 363LP2300X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology