Provider Demographics
NPI:1891776704
Name:MCCLEMENTS, MARY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:MCCLEMENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W CLARKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1840
Mailing Address - Country:US
Mailing Address - Phone:302-430-5435
Mailing Address - Fax:302-430-5644
Practice Address - Street 1:21 W CLARKE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1840
Practice Address - Country:US
Practice Address - Phone:302-430-5435
Practice Address - Fax:302-430-5644
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007002207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E55840Medicare UPIN
012348P41Medicare ID - Type Unspecified