Provider Demographics
NPI:1619080926
Name:HILL, CLARENCE EUGENE JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:EUGENE
Last Name:HILL
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-775-6466
Mailing Address - Fax:508-775-6473
Practice Address - Street 1:51 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-775-6466
Practice Address - Fax:508-775-6473
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1480213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
33007OtherHARVARD PILGRIM HEALTH PL
731802OtherTUFTS HEALTH PLAN
731802OtherTUFTS HEALTH PLAN
Y77042Medicare ID - Type UnspecifiedGROUP NUMBER