Provider Demographics
NPI:1679586275
Name:CLANCY, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:CLANCY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 BURNET AVE., ML 2021
Mailing Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-6771
Mailing Address - Fax:513-636-4615
Practice Address - Street 1:3333 BURNET AVE., ML 2021
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-6771
Practice Address - Fax:513-636-4615
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-04-21
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Provider Licenses
StateLicense IDTaxonomies
OH35.0968682080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503748Medicaid
AL09523863OtherMS MEDICAID
AL009969010Medicaid
AL051503748OtherBCBS OF AL
AL290014033OtherRR MEDICARE
AL051503749OtherBCBS OF AL
AL051503749OtherBCBS OF AL