Provider Demographics
NPI:1326247909
Name:CLEMENTSON, BLAIR WETMORE (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:WETMORE
Last Name:CLEMENTSON
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 1:2020 N CHURCH STREET PL
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2706
Mailing Address - Country:US
Mailing Address - Phone:864-582-3447
Mailing Address - Fax:864-582-3449
Practice Address - Street 1:2020 N CHURCH STREET PL
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2706
Practice Address - Country:US
Practice Address - Phone:864-582-3447
Practice Address - Fax:864-582-3449
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29902207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology