MEDICARE: DAVID J CLAIN 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	207RG0100X	Gastroenterology Physician	138832	NY

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

General Provider Information

NPI Number	:	1114902343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J CLAIN MD

Provider Business Mailing Address
First Line	:	PO BOX 32886
Second Line	:	BETH ISRAEL MEDICAL CENTER, DEPT OF GASTROENTEROLOGY
City	:	HARTFORD
State	:	CT
Zip	:	06150-2886
Country	:	US
Telephone Number	:	212-420-4521
Fax Number	:	212-420-4373

Provider Business Practice Location Address
First Line	:	10 UNION SQUARE E
Second Line	:	#2G, PHILLIPS AMBULATORY CARE CENTER
City	:	NEW YORK
State	:	NY
Zip	:	10003-3801
Country	:	US
Telephone Number	:	212-420-4521
Fax Number	:	212-420-4373

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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Directions to “ DAVID J CLAIN MD” Practice Location

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