Provider Demographics
NPI:1972828424
Name:CLEMENTS, CATHERINE E (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E
Last Name:CLEMENTS
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 1:7602 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4088
Mailing Address - Country:US
Mailing Address - Phone:410-663-8100
Mailing Address - Fax:410-663-8119
Practice Address - Street 1:7602 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-663-8100
Practice Address - Fax:410-663-8119
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD75816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program