Individual
RICHARD THOMAS CLEARY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 PARK ST, GLENS FALLS HOSPITAL NEUROLOGY, GLENS FALLS, NY 12801-4403
(518) 926-2940
(518) 926-2941
Mailing address
100 PARK STREET, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-4413
(518) 926-5924
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2021-03205
NC
2084N0400X
Neurology Physician
266931
NY
2084N0400X
Neurology Physician
27116
MS
2084N0400X
Neurology Physician
52978
TN
2084N0400X
Neurology Physician
E-12508
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03767571
—
NY
Enumeration date
05/11/2010
Last updated
01/15/2026
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