Provider Demographics
NPI:1164385654
Name:WAUGH, CLINTON CORNELL
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:CORNELL
Last Name:WAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 DOEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1015
Mailing Address - Country:US
Mailing Address - Phone:202-615-0818
Mailing Address - Fax:
Practice Address - Street 1:1735 33RD PL SE APT 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2377
Practice Address - Country:US
Practice Address - Phone:301-640-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant