Organization · Type 2 NPI

Cleanslate Medical Group of Pennsylvania LLC

Multi-Specialty Clinic/Center · Wilkes Barre, PA

NPI number 1184177263 Active

Practice location

100 N Wilkes Barre Blvd Ste 103
Wilkes Barre, PA 18702-5240

Call (413) 584-2173 Map

Fax (833) 279-7074

Mailing address

155 Franklin Rd Ste 430
Brentwood, TN 37027-1602

Specialties and licenses

TaxonomyCodeLicense
Addiction Medicine (Internal Medicine) Physician 207RA0401XNone listed
Multi-Specialty Clinic/Center Primary 261QM1300XNone listed

Multi-Specialty Clinic/Center: Definition to come...

12 other providers at this address

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About NPI 1184177263

Cleanslate Medical Group of Pennsylvania LLC's National Provider Identifier is 1184177263, issued on Jul 26, 2016. The primary taxonomy on file is Multi-Specialty Clinic/Center (261QM1300X), and the practice location is in Wilkes Barre, PA. The record was last updated on Aug 26, 2026.