Provider Demographics
NPI:1508834201
Name:CLEMENT, RITA A (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:A
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SOUTH AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-256-3000
Mailing Address - Fax:585-256-3045
Practice Address - Street 1:990 SOUTH AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-256-3000
Practice Address - Fax:585-256-3045
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5361700OtherAETNA
NY101611CKOtherPREFERRED CARE
10474003OtherCAQH
NY01852088Medicaid
NYCC0747Medicare ID - Type Unspecified
5361700OtherAETNA