Provider Demographics
NPI:1083683510
Name:CLONINGER, TIMOTHY E (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:CLONINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:8310 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3383
Practice Address - Country:US
Practice Address - Phone:704-547-8762
Practice Address - Fax:704-547-1632
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150352085R0001X
SC138562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC26019OtherPARTNERS MEDICARE
SCE23143Medicaid
NC1561042009OtherCIGNA
NC8923143Medicaid
NC2086198OtherUNITED HEALTHCARE
NC23143OtherBLUE CROSS
NC58014OtherMEDCOST
NC212058FMedicare ID - Type UnspecifiedLAKE NORMAN RAD ONC CTR
NC212058Medicare ID - Type Unspecified
NC1561042009OtherCIGNA
NC212058EMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR
NC212058CMedicare ID - Type UnspecifiedUNIVERSITY RAD ONC CTR