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NPI Code Detail

MEDICARE: DR. PAUL J CLANCY M.D.

MEDICARE: DR. PAUL J CLANCY M.D.
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
1207P00000XEmergency Medicine Physician18263WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3930118819OTHERWVCH2 RAILROAD MEDICARE
5930114604OTHERWVCH1 RAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11053515OTHERWVWV DWC
2001718060OTHERWVWV BCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285611327
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL J CLANCY M.D.
Provider Business Mailing Address
First Line : 200 HOSPITAL DR
Second Line :
City : SPENCER
State : WV
Zip : 25276-1050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 HOSPITAL DR
Second Line :
City : SPENCER
State : WV
Zip : 25276-1050
Country : US
Telephone Number : 304-927-6819
Fax Number : 304-927-6837
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 01/20/2011

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Directions to “ DR. PAUL J CLANCY M.D.” Practice Location

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