Provider Demographics
NPI:1003998964
Name:CLEMENCY, KAREN ALICE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ALICE
Last Name:CLEMENCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3867
Mailing Address - Country:US
Mailing Address - Phone:614-208-0361
Mailing Address - Fax:614-564-9167
Practice Address - Street 1:1020 DENNISON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3497
Practice Address - Country:US
Practice Address - Phone:614-564-9067
Practice Address - Fax:614-564-9167
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053771207Q00000X
OH033288551835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0667587Medicaid
04705850173OtherMEDICAL EDUCATION NUMBER
04705850173OtherMEDICAL EDUCATION NUMBER
OH0667587Medicaid