Provider Demographics
NPI:1952390494
Name:CLEM, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:CLEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-289-6241
Mailing Address - Fax:410-289-5533
Practice Address - Street 1:1001 PHILADELPHIA AVENUE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842
Practice Address - Country:US
Practice Address - Phone:410-289-6241
Practice Address - Fax:410-289-5533
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0058701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD432132400Medicaid
MDKP95D518Medicare ID - Type Unspecified
MD432132400Medicaid