Provider Demographics
NPI:1285636514
Name:CLEARY, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:CLEARY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:STE 307
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1715
Mailing Address - Country:US
Mailing Address - Phone:703-391-8804
Mailing Address - Fax:703-391-5659
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 307
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1715
Practice Address - Country:US
Practice Address - Phone:703-391-8804
Practice Address - Fax:703-391-5659
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-11-26
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Provider Licenses
StateLicense IDTaxonomies
VA0101026305207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6077277Medicaid
B06380Medicare UPIN
DC022799Medicare PIN