Provider Demographics
NPI:1659314748
Name:SKARDA, JOHN CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLAYTON
Last Name:SKARDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 SHANNON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6322
Mailing Address - Country:US
Mailing Address - Phone:800-291-4020
Mailing Address - Fax:919-419-7247
Practice Address - Street 1:434 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:800-291-4020
Practice Address - Fax:919-419-7247
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32865207P00000X, 207Q00000X
TN54731207Q00000X
VA0101260969207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513475Medicaid
VA1659314748Medicaid
VAVVM279AMedicare PIN
TN103I089112Medicare PIN