Provider Demographics
NPI:1093791352
Name:CLINE, NANCY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:CLINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 WYKE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4259
Mailing Address - Country:US
Mailing Address - Phone:704-482-6767
Mailing Address - Fax:704-600-6232
Practice Address - Street 1:1170 WYKE RD.
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3406
Practice Address - Country:US
Practice Address - Phone:704-482-6767
Practice Address - Fax:704-484-2507
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20157207W00000X
NC98 01213207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11512OtherBCBS
2257439OtherMC SOUTH CAROLINA
561705541OtherCMS 1500
NC8911512Medicaid
561705541OtherHEALTHSOURCE SC INC
561705541OtherAETNA
11512OtherBLUE CROSS BLUE SHIELD
0841483OtherUNITED HEALTH CARE
2075830OtherFIRST HEALTH
2109354OtherMAMSI INSURANCE
SC11512OtherBCBS
NC561705541OtherWORKMANS COMP
SC561705541OtherWORKMANS COMP
561705541OtherCMS 1500
2257439Medicare ID - Type Unspecified
SC561705541OtherWORKMANS COMP
NC8911512Medicaid