Provider Demographics
NPI:1619935327
Name:MEGAN CLANCY, MD, LLC
Entity Type:Organization
Organization Name:MEGAN CLANCY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-561-4362
Mailing Address - Street 1:3500 LATOUCHE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4248
Mailing Address - Country:US
Mailing Address - Phone:907-561-4361
Mailing Address - Fax:907-563-4498
Practice Address - Street 1:3500 LATOUCHE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4248
Practice Address - Country:US
Practice Address - Phone:907-561-4361
Practice Address - Fax:907-563-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK160305Medicare PIN