Provider Demographics
NPI:1669468237
Name:CLEGG, HERBERT II (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:CLEGG
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-8800
Mailing Address - Fax:704-384-8819
Practice Address - Street 1:517 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2975
Practice Address - Country:US
Practice Address - Phone:704-384-8800
Practice Address - Fax:704-384-8819
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26211208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN26211Medicaid
NC8922984Medicaid
NCF42951Medicare UPIN
NC8922984Medicaid