MEDICARE: RYAN DAVID CLEMENT PA-C

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	363A00000X	Physician Assistant	102770	NC

General Provider Information

NPI Number	:	1598712572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DAVID CLEMENT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	919-220-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 DURALEIGH RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8106
Country	:	US
Telephone Number	:	919-220-5255
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/15/2023

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