Provider Demographics
NPI:1265659916
Name:CLEMONS FERRARA, CLARISSE D (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSE
Middle Name:D
Last Name:CLEMONS FERRARA
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 1:89 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1978
Mailing Address - Country:US
Mailing Address - Phone:860-303-9000
Mailing Address - Fax:860-599-3479
Practice Address - Street 1:9 CASTLE HILL RD
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1958
Practice Address - Country:US
Practice Address - Phone:860-303-9000
Practice Address - Fax:860-599-3479
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150089207P00000X
CT048178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT048178OtherCONNECTICUT LICENSE
NY150089-1OtherLICENSE