Provider Demographics
NPI:1265549240
Name:CLARE, CHARLOTTE NANETTE (MD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:NANETTE
Last Name:CLARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:
Other - Last Name:CLARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:UTHSCSA, UTHSCSA, DEPT. OF PATHOLOGY
Mailing Address - Street 2:7703 FLOYD CURL DRIVE, RM 328B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-592-0400
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-257-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5321207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102348302OtherCIDC
TX102348301Medicaid
TX220009951Medicare PIN
TX81P763Medicare PIN