Provider Demographics
NPI:1629064399
Name:CLEMO, SIMON HENRY (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:HENRY
Last Name:CLEMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1201 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4490
Mailing Address - Country:US
Mailing Address - Phone:540-741-5501
Mailing Address - Fax:540-741-9756
Practice Address - Street 1:1201 SAM PERRY BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4490
Practice Address - Country:US
Practice Address - Phone:540-741-5501
Practice Address - Fax:540-741-9756
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101042893207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003596V55Medicare PIN
E95138Medicare UPIN