Provider Demographics
NPI:1326276551
Name:CLYBURN-IPOCK, VIRGINIA LEE (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:CLYBURN-IPOCK
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 1:4375 BETHUNE HWY
Mailing Address - Street 2:
Mailing Address - City:BETHUNE
Mailing Address - State:SC
Mailing Address - Zip Code:29009-9334
Mailing Address - Country:US
Mailing Address - Phone:803-484-2602
Mailing Address - Fax:
Practice Address - Street 1:555 EAST CHEVES ST
Practice Address - Street 2:MCLEOD HEALTH HOSPITAL - RADIATION ONCOLOGY
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-777-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL317242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology