Provider Demographics
NPI:1306951645
Name:CLINTON, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:CLINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:129 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1412
Mailing Address - Country:US
Mailing Address - Phone:413-536-5563
Mailing Address - Fax:413-536-1199
Practice Address - Street 1:129 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1412
Practice Address - Country:US
Practice Address - Phone:413-536-5563
Practice Address - Fax:413-536-1199
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
100639OtherCIGNA
707257OtherCONNECTICARE
44311620OtherPALMETTO GBA
043007257001OtherTRICARE
71754OtherHARVARD PILGRIM
11363OtherHEALTH NEW ENGLAND
N6119OtherKAISER
000000007785OtherBMC HEALTHNET PLAN
042642OtherTUFTS
MA2061236Medicaid
707257OtherCONNECTICARE
G19017Medicare ID - Type Unspecified