Provider Demographics
NPI:1932281987
Name:MCLEMORE, CYNTHIA WELLS (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:WELLS
Last Name:MCLEMORE
Suffix:
Gender:F
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 4534
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4534
Mailing Address - Country:US
Mailing Address - Phone:910-331-5623
Mailing Address - Fax:
Practice Address - Street 1:1496 JUNIPER LAKE ROAD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8913
Practice Address - Country:US
Practice Address - Phone:910-331-5623
Practice Address - Fax:866-481-8357
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26678208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950341Medicaid
NC2281162AMedicare ID - Type Unspecified
2281162CMedicare PIN
NC8950341Medicaid