Healthcare Provider Details

I. General information

NPI: 1669054367
Provider Name (Legal Business Name): RONALD MCDONALD CLEARIE III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 ROUTE 73 STE A
VOORHEES NJ
08043-9598
US

IV. Provider business mailing address

33 CLYDESDALE CT
TINTON FALLS NJ
07701-4902
US

V. Phone/Fax

Practice location:
  • Phone: 877-388-2778
  • Fax:
Mailing address:
  • Phone: 732-693-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MB13191400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: