Provider Demographics
NPI:1649236282
Name:CLERMONT, HARVEY GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:GERALD
Last Name:CLERMONT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARVEY
Other - Middle Name:GERALD
Other - Last Name:CLERMONT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:37 KNOLLWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3329
Mailing Address - Country:US
Mailing Address - Phone:508-845-6024
Mailing Address - Fax:508-842-9372
Practice Address - Street 1:37 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3329
Practice Address - Country:US
Practice Address - Phone:508-845-6024
Practice Address - Fax:508-842-9372
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35288208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9900023OtherFALLON
MA0026191OtherNHP
MAN01584OtherBLUE SHEILD
MA3100227Medicaid
MA401633OtherTH
MA540380OtherCIGNA
MA808035OtherHARVARDPILGRIM
MA0026191OtherNHP
MAB98834Medicare UPIN