MEDICARE: MARIANNE CLINTON 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
1	207Q00000X	Family Medicine Physician	G50695	CA
2	207Q00000X	Family Medicine Physician	167056	OR
3	207Q00000X	Family Medicine Physician	29208	MN
4	207Q00000X	Family Medicine Physician	298988-1	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871561951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE CLINTON M.D.

Provider Business Mailing Address
First Line	:	280 HENRY ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-4816
Country	:	US
Telephone Number	:	212-227-8401
Fax Number	:	212-227-8842

Provider Business Practice Location Address
First Line	:	1427 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4202
Country	:	US
Telephone Number	:	347-390-8706
Fax Number	:	347-396-9785

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/02/2025

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