Healthcare Provider Details

I. General information

NPI: 1124016217
Provider Name (Legal Business Name): JUDE F CLANCY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SAYBROOK RD
MIDDLETOWN CT
06457-4859
US

IV. Provider business mailing address

420 SAYBROOK RD
MIDDLETOWN CT
06457-4859
US

V. Phone/Fax

Practice location:
  • Phone: 203-678-1050
  • Fax: 860-696-2045
Mailing address:
  • Phone: 203-678-1050
  • Fax: 860-696-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number037893
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: