Organization
CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
Active
Organization
CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ROGERS ANDERSON (VICE PRESIDENT)
(615) 425-0220
Entity
Organization
Contact information
Practice address
100 N WILKES BARRE BLVD STE 103, WILKES BARRE, PA 18702-5240
(413) 584-2173
(833) 279-7074
Mailing address
155 FRANKLIN RD STE 430, BRENTWOOD, TN 37027-1602
(615) 425-0220
(833) 279-7074
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/26/2016
Last updated
08/26/2026
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