Provider Demographics
NPI:1437172087
Name:CLANCY, DEBRA J (MED)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ERROR
Other - Middle Name:ERROR
Other - Last Name:ERROR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ERROR
Mailing Address - Street 1:1000 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4739
Mailing Address - Country:US
Mailing Address - Phone:401-533-9100
Mailing Address - Fax:
Practice Address - Street 1:1000 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4739
Practice Address - Country:US
Practice Address - Phone:401-533-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412296OtherEI BLUECHIP
RI2092OtherEI NHPRC
RI6400144OtherEIUHP
RI292177OtherEI BLUE CROSS