Provider Demographics
NPI:1427214790
Name:CLANCY, CHRISTOPHER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:CLANCY
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 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-226-5018
Mailing Address - Fax:419-998-4514
Practice Address - Street 1:1003 BELLEFONTAINE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1803
Practice Address - Country:US
Practice Address - Phone:419-227-7702
Practice Address - Fax:419-227-7991
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNOT ISSUED YET208600000X
IL036134710208G00000X
IN01078894A208G00000X
OH35.120842208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery