Healthcare Provider Details

I. General information

NPI: 1679586275
Provider Name (Legal Business Name): JOHN P CLANCY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE., ML 2021 CINCINNATI CHILDREN'S HOSPITAL
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE., ML 2021 CINCINNATI CHILDREN'S HOSPITAL
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-6771
  • Fax: 513-636-4615
Mailing address:
  • Phone: 513-636-6771
  • Fax: 513-636-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35.096868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: