Provider Demographics
NPI:1861449662
Name:CLARE, WILLIAM P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:CLARE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:STE 170
Practice Address - City:CHAS
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-763-3700
Practice Address - Fax:843-763-3714
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110164415OtherRAILROAD MEDICARE
SC110231394OtherRAILROAD MEDICARE
SC144251Medicaid
SCP00727205OtherRAILROAD MEDICARE ID-RSFPN
SCF958224887Medicare PIN
SC1497874424Medicare PIN
SC110231394OtherRAILROAD MEDICARE
SCF958229223Medicare PIN
SCF958226795Medicare PIN
SC1558313080Medicare PIN