Provider Demographics
NPI:1427026210
Name:CLYNE, STEPHEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:CLYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:10512 PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8475
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-838-8494
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01229207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20079900OtherSELECT HEALTH OF SC
SC772913OtherWELLCARE
SCN0122AMedicaid
NC4823670OtherCIGNA
NC7368564OtherAETNA
SC80401OtherCHCCARES OF SC
NC1377KOtherBCBS
NC3476629OtherAETNA HMO/EPO/SELECT
NCD3210OtherMEDCOST
NC2422065OtherUNITED HEALTHCARE
NC891377Medicaid
NC4823670OtherCIGNA
SC20079900OtherSELECT HEALTH OF SC
I04359Medicare UPIN