Provider Demographics
NPI:1538331897
Name:CLOUGH, MARIA HENRIETTE (MS, MMSC, PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:HENRIETTE
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:MS, MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2636
Mailing Address - Country:US
Mailing Address - Phone:603-542-6455
Mailing Address - Fax:
Practice Address - Street 1:252 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2636
Practice Address - Country:US
Practice Address - Phone:603-542-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical