Healthcare Provider Details

I. General information

NPI: 1548528573
Provider Name (Legal Business Name): CLAYTON ALAN CARMODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

IV. Provider business mailing address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

V. Phone/Fax

Practice location:
  • Phone: 513-347-9999
  • Fax: 513-232-2522
Mailing address:
  • Phone: 513-347-9999
  • Fax: 513-232-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD60763576
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35134940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: