Provider Demographics
NPI:1144220328
Name:CLEMENT, PHILLIP A III (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:CLEMENT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3520
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:PITT COUNTY MEMORIAL HOSPITAL
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-2207
Practice Address - Fax:252-744-5014
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9800024207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1135AOtherBCBS NC
NC930062093OtherRAILROAD MEDICARE
NC891135AMedicaid
NC930062093OtherRAILROAD MEDICARE
NC2253635Medicare ID - Type Unspecified