Provider Demographics
NPI:1538194832
Name:KLEMENS, SALLY P (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:P
Last Name:KLEMENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:INFECTIOUS DISEASE CONSULTANTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-6253
Mailing Address - Fax:315-448-6264
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:INFECTIOUS DISEASE CONSULTANTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-6253
Practice Address - Fax:315-448-6264
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176468-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01149540Medicaid
NYF07269Medicare UPIN
NYCC6702Medicare PIN
NYBB1382Medicare PIN