Provider Demographics
NPI:1598741357
Name:CLEMENTS, CHARLES PAUL III (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PAUL
Last Name:CLEMENTS
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-1320
Practice Address - Country:US
Practice Address - Phone:302-733-1000
Practice Address - Fax:302-733-2685
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN334205L207L00000X
DEL6-0A00734367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1598741357Medicaid
S61351Medicare UPIN
PA058012Medicare ID - Type Unspecified
DE433030YOJMedicare UPIN