Provider Demographics
NPI:1407927445
Name:CLEMENTE, MARC GENNARO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:GENNARO
Last Name:CLEMENTE
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 1:575 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8977
Mailing Address - Country:US
Mailing Address - Phone:614-899-6167
Mailing Address - Fax:614-899-6067
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-899-6167
Practice Address - Fax:614-899-6067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 0476562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0516730Medicaid
OHCL 7241701Medicare ID - Type Unspecified
OH0516730Medicaid