Provider Demographics
NPI:1821147836
Name:CLOWSE, MARTIN C (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:C
Last Name:CLOWSE
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:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:919-477-6900
Mailing Address - Fax:919-544-6210
Practice Address - Street 1:5107 SOUTHPARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8400
Practice Address - Country:US
Practice Address - Phone:919-477-6900
Practice Address - Fax:919-544-6210
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901690Medicaid
NC2044011BMedicare PIN
NC5901690Medicaid
NC2044011Medicare PIN
H00229Medicare UPIN