Basic Information
| Provider Information | |||||||||
| NPI: | 1336230416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLOSSON | ||||||||
| FirstName: | CAREY-WALTER | ||||||||
| MiddleName: | FRANKLIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK RD | ||||||||
| Address2: | EXECUTIVE PLAZA 1, SUITE 501 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210311002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014647008 | ||||||||
| FaxNumber: | 3014647011 | ||||||||
| Practice Location | |||||||||
| Address1: | 16900 SCIENCE DR | ||||||||
| Address2: | STE100 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207154401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014647008 | ||||||||
| FaxNumber: | 3014647011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | D0059643 | MD | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 336423200 | 05 | MD | MEDICAID |