Provider Demographics
NPI:1720222425
Name:MOCK, CLARE KELLEHER (MD)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:KELLEHER
Last Name:MOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:JOHNSON
Other - Last Name:KELLEHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 WATERSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278
Practice Address - Country:US
Practice Address - Phone:984-974-1931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74217207R00000X
NC2014-00720208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055904100Medicaid
MD242940Y82Medicare PIN