1083683510 NPI number — DR. TIMOTHY E CLONINGER M.D.

Table of content: DR. TIMOTHY E CLONINGER M.D. (NPI 1083683510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083683510 NPI number — DR. TIMOTHY E CLONINGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLONINGER
Provider First Name:
TIMOTHY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083683510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 QUEENS RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28204-3252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-333-7376
Provider Business Mailing Address Fax Number:
704-333-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8310 UNIVERSITY EXEC PARK DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-547-8762
Provider Business Practice Location Address Fax Number:
704-547-1632
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  15035 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X , with the licence number: 13856 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26019 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: E23143 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1561042009 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8923143 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2086198 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 23143 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 58014 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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