Provider Demographics
NPI:1407962228
Name:CLOTFELTER, LUCILE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCILE
Middle Name:
Last Name:CLOTFELTER
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 1:4220 APEX HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5295
Mailing Address - Country:US
Mailing Address - Phone:919-932-5700
Mailing Address - Fax:919-933-6881
Practice Address - Street 1:4220 APEX HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5295
Practice Address - Country:US
Practice Address - Phone:919-932-5700
Practice Address - Fax:919-933-6881
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC317932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904640Medicaid