Provider Demographics
NPI:1245287663
Name:CLAGUE, HEATHER WHIPPLE (MD)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:WHIPPLE
Last Name:CLAGUE
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 1:6355 TELEGRAPH AVE
Mailing Address - Street 2:SUIT 203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1371
Mailing Address - Country:US
Mailing Address - Phone:519-869-4999
Mailing Address - Fax:510-985-7347
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:SUIT 203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1371
Practice Address - Country:US
Practice Address - Phone:519-869-4999
Practice Address - Fax:510-985-7347
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1855522084P0800X
CAA732072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH88400Medicare UPIN