Provider Demographics
NPI:1649228552
Name:CLANCY, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CHESTER PIKE STE 201
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4540
Mailing Address - Country:US
Mailing Address - Phone:610-449-9666
Mailing Address - Fax:610-449-9822
Practice Address - Street 1:525 W CHESTER PIKE STE 201
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4540
Practice Address - Country:US
Practice Address - Phone:610-449-9666
Practice Address - Fax:610-449-9822
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4863207R00000X, 208D00000X
PAMD418776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19OPMedicaid
AKHS19IPMedicaid
AKHS19IPMedicaid
AKTEZ042Medicare PIN