MEDICARE: KAREN ALICE CLEMENCY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35053771	OH
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03328855	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	04705850173	OTHER		MEDICAL EDUCATION NUMBER

General Provider Information

NPI Number	:	1003998964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ALICE CLEMENCY MD

Provider Business Mailing Address
First Line	:	1608 LAFAYETTE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3867
Country	:	US
Telephone Number	:	614-208-0361
Fax Number	:	614-564-9167

Provider Business Practice Location Address
First Line	:	1020 DENNISON AVE
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3497
Country	:	US
Telephone Number	:	614-564-9067
Fax Number	:	614-564-9167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/15/2020

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