Provider Demographics
NPI:1457566606
Name:CLANCY, RYAN JOSEPH (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JOSEPH
Last Name:CLANCY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1412 FAIRMOUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:215-599-4851
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:120 S 30TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3403
Practice Address - Country:US
Practice Address - Phone:215-222-2466
Practice Address - Fax:215-222-2462
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2011-03-23
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Provider Licenses
StateLicense IDTaxonomies
PAMA051812363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical