Provider Demographics
NPI:1700250974
Name:CLEMENT, JEANNINE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:DENISE
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1425 STATE ROUTE 142 NE
Mailing Address - Street 2:JM-7-50-WJ
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-9647
Mailing Address - Country:US
Mailing Address - Phone:614-424-5236
Mailing Address - Fax:614-424-3107
Practice Address - Street 1:1425 STATE ROUTE 142 NE
Practice Address - Street 2:JM-7-50-WJ
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-9647
Practice Address - Country:US
Practice Address - Phone:614-424-5236
Practice Address - Fax:614-424-3107
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA453122083X0100X
OH35-0541642083X0100X
WAMD602561192083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine