Provider Demographics
NPI:1407809924
Name:CLINTON, H LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:H LOUIS
Middle Name:
Last Name:CLINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:67 PROSPECT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2907
Mailing Address - Country:US
Mailing Address - Phone:518-828-2566
Mailing Address - Fax:518-697-3403
Practice Address - Street 1:67 PROSPECT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2907
Practice Address - Country:US
Practice Address - Phone:518-828-2566
Practice Address - Fax:518-697-3403
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-163259207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
040426007295OtherFIDELIS
600461OtherUNITED HEALTHCARE
000406283001OtherBS OF NENY
0036315OtherGHI PPO
105180OtherWELLCARE
5180OtherGHI HMO
NY01094820Medicaid
10000352OtherCDPHP
320532OtherMVP
717002OtherBC/BS
P902860OtherOXFORD
000406283001OtherBS OF NENY
600461OtherUNITED HEALTHCARE
NYA61855Medicare UPIN
GA010021079Medicare PIN