Provider Demographics
NPI:1386643419
Name:CLARY, RICHARD HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HENRY
Last Name:CLARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WEST TOWN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1514
Mailing Address - Country:US
Mailing Address - Phone:614-228-3874
Mailing Address - Fax:614-228-3883
Practice Address - Street 1:717 WEST TOWN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1514
Practice Address - Country:US
Practice Address - Phone:614-228-3874
Practice Address - Fax:614-228-3883
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350325192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187355Medicaid
C00908Medicare UPIN
CL0367175Medicare PIN