Provider Demographics
NPI:1720040108
Name:CLEMENTS, WILLIAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-2116
Mailing Address - Country:US
Mailing Address - Phone:610-678-9841
Mailing Address - Fax:610-678-8168
Practice Address - Street 1:260 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-2116
Practice Address - Country:US
Practice Address - Phone:610-678-9841
Practice Address - Fax:610-678-8168
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025869E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0951009Medicaid
PA129858Medicare ID - Type Unspecified
PA0951009Medicaid