Provider Demographics
NPI:1558353375
Name:CLANCY, CATHLEEN
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 NEW MEXICO AVE NW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2756
Mailing Address - Country:US
Mailing Address - Phone:202-362-3867
Mailing Address - Fax:
Practice Address - Street 1:3201 NEW MEXICO AVE NW
Practice Address - Street 2:SUITE 310
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2756
Practice Address - Country:US
Practice Address - Phone:202-362-3867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC19600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30627Medicare UPIN