Provider Demographics
NPI:1083618987
Name:PEARSON, CLARENCE E (MD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:E
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5372
Mailing Address - Fax:
Practice Address - Street 1:1107B BROOKDALE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4501
Practice Address - Country:US
Practice Address - Phone:276-634-4400
Practice Address - Fax:276-638-2900
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033368207RC0000X
NM2003-0352207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21931828Medicaid
NM21931828Medicaid
NMNPI & TAX IDOtherBCBS OF NM
NM21931828Medicaid
NMP00734829OtherRAILROAD MEDICARE