Provider Demographics
NPI:1831146273
Name:CLEMENT, LORETTA A (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:A
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2692 MADISON RD STE N1
Mailing Address - Street 2:# 365
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2692 MADISON RD STE N1
Practice Address - Street 2:# 365
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1320
Practice Address - Country:US
Practice Address - Phone:513-739-1944
Practice Address - Fax:513-353-7258
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1636207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE29710Medicare UPIN