Provider Demographics
NPI:1902911811
Name:CLAUSS, PATRICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:CLAUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-0067
Mailing Address - Country:US
Mailing Address - Phone:570-842-7060
Mailing Address - Fax:570-842-1752
Practice Address - Street 1:328 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444
Practice Address - Country:US
Practice Address - Phone:570-842-7060
Practice Address - Fax:570-842-1752
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002564L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009962160001Medicaid
PA0009962160001Medicaid
105502Medicare ID - Type Unspecified