Provider Demographics
NPI:1912942053
Name:WASHINGTON, CLARENCE DANIEL (MD)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:DANIEL
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:780 SWIFT BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:509-943-1880
Mailing Address - Fax:509-943-3443
Practice Address - Street 1:3730 PLAZA WA
Practice Address - Street 2:FLOOR 4
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-221-6450
Practice Address - Fax:509-221-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000146372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023720Medicaid
A07426Medicare UPIN
WAG000301712Medicare ID - Type Unspecified