Provider Demographics
NPI:1609895523
Name:CLINCH, MARIAN BARTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:BARTON
Last Name:CLINCH
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:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641
Mailing Address - Country:US
Mailing Address - Phone:864-644-8977
Mailing Address - Fax:864-644-8975
Practice Address - Street 1:300 FLEETWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640
Practice Address - Country:US
Practice Address - Phone:864-644-8977
Practice Address - Fax:864-644-8975
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1804Medicaid
SC5664Medicare PIN