Provider Demographics
NPI:1053395491
Name:CLINGERMAN, MERCEDES LEE (PAC)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:LEE
Last Name:CLINGERMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:LEE
Other - Last Name:CLINGERMAN MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:VALLEY MEDICAL GROUP
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-256-8561
Mailing Address - Fax:
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:VALLEY MEDICAL GROUP
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1588363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP 1990Medicare ID - Type Unspecified