Provider Demographics
NPI:1235853847
Name:PATRICIA A MCCLERKLIN, MD, PA
Entity Type:Organization
Organization Name:PATRICIA A MCCLERKLIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLERKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-422-6921
Mailing Address - Street 1:112 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6503
Mailing Address - Country:US
Mailing Address - Phone:803-771-9163
Mailing Address - Fax:803-771-7383
Practice Address - Street 1:112 DOCTOR CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6503
Practice Address - Country:US
Practice Address - Phone:803-771-9163
Practice Address - Fax:803-771-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty