Provider Demographics
NPI:1538523683
Name:CLEMENT, VIRGINIA (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:CLEMENT
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 1:1330 OAKRIDGE DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9651
Mailing Address - Country:US
Mailing Address - Phone:970-484-4871
Mailing Address - Fax:
Practice Address - Street 1:1330 OAKRIDGE DR UNIT 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9651
Practice Address - Country:US
Practice Address - Phone:970-484-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0064407208000000X
CAA153361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics