Provider Demographics
NPI:1053374264
Name:CLARY, MICHAEL HOWARD (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:CLARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7017
Mailing Address - Country:US
Mailing Address - Phone:540-443-7187
Mailing Address - Fax:540-443-7182
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-443-7187
Practice Address - Fax:540-443-7182
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10031748OtherOPTIMA/SENTARA
VA296203OtherMAMSI PROVIDER NUMBER
VA830370OtherUNITED HEALTHCARE
VA005881153Medicaid
VA4283942OtherCIGNA PROVIDER NUMBER
VAP00805146OtherMEDICARE RR
VA4652869OtherAETNA
VATN0101OtherJOHN DEERE PROVIDER
VA4652869OtherAETNA PROVIDER NUMBER
VA4283942OtherCIGNA
WV1003599OtherBRICKSTREET-WV COMP
VA158189OtherSOUTHERN HEALTH PROVIDER
VA238819OtherANTHEM
VA296203OtherMAMSI PROVIDER NUMBER
VA4652869OtherAETNA
VATN0101OtherJOHN DEERE PROVIDER
VA012368A18Medicare PIN