Provider Demographics
NPI:1972566396
Name:CLEMENS, SUSAN V (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:V
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 511
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-737-4420
Mailing Address - Fax:401-737-9934
Practice Address - Street 1:400 BALD HILL ROAD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-232-7001
Practice Address - Fax:401-232-7388
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD07650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007006249Medicare PIN
RI007010160Medicare PIN
939020520Medicare PIN
089023187Medicare PIN