Provider Demographics
NPI:1124016217
Name:CLANCY, JUDE F (MD)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:F
Last Name:CLANCY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9805
Mailing Address - Street 2:300 GEORGE STREET 6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 GOOSE LN
Practice Address - Street 2:YALE NEW HAVEN SHORELINE MEDICAL CENTER STE 2400
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-5101
Practice Address - Country:US
Practice Address - Phone:203-458-2097
Practice Address - Fax:203-458-1592
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037893207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001378935Medicaid
CT110008313Medicare ID - Type Unspecified
H09133Medicare UPIN