Provider Demographics
NPI:1194847707
Name:CLAREY, KRISTEN SAMUHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SAMUHEL
Last Name:CLAREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:SAMUHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1125 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1007
Mailing Address - Country:US
Mailing Address - Phone:336-832-7486
Mailing Address - Fax:336-832-7078
Practice Address - Street 1:1125 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1007
Practice Address - Country:US
Practice Address - Phone:336-832-7486
Practice Address - Fax:336-832-7078
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZR0000117Medicare UPIN