Provider Demographics
NPI:1083627624
Name:MCCLURE, MARK WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WARREN
Last Name:MCCLURE
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 1:221B PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4303
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-9469
Practice Address - Street 1:221B PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4303
Practice Address - Country:US
Practice Address - Phone:252-247-2101
Practice Address - Fax:252-247-9469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33672208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955822Medicaid
NC0113JOtherBCBS
NC0113JOtherBCBS
NC8955822Medicaid