Provider Demographics
NPI:1861665184
Name:HANA J. CLEMENTS, M.D., LLC
Entity Type:Organization
Organization Name:HANA J. CLEMENTS, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-366-1122
Mailing Address - Street 1:2228 BLACK ROCK TPKE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3237
Mailing Address - Country:US
Mailing Address - Phone:203-366-1122
Mailing Address - Fax:203-366-0840
Practice Address - Street 1:2228 BLACK ROCK TPKE
Practice Address - Street 2:SUITE 208
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3237
Practice Address - Country:US
Practice Address - Phone:203-366-1122
Practice Address - Fax:203-366-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03436Medicare PIN
CTG63826Medicare UPIN