Provider Demographics
NPI:1174012546
Name:DE CLEMENTE, ERICA (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DE CLEMENTE
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 1:30 OLD MARGAREE ROAD
Mailing Address - Street 2:
Mailing Address - City:BADDECK
Mailing Address - State:NOVA SCOTIA
Mailing Address - Zip Code:B0E 1B0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 OLD MARGAREE ROAD
Practice Address - Street 2:
Practice Address - City:BADDECK
Practice Address - State:NOVA SCOTIA
Practice Address - Zip Code:B0E 1B0
Practice Address - Country:CA
Practice Address - Phone:902-295-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program