Provider Demographics
NPI:1801876909
Name:CLEVENGER, JEFFREY CABOT (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CABOT
Last Name:CLEVENGER
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:300 PALMETTO HEALTH PKWY STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1764
Practice Address - Country:US
Practice Address - Phone:803-434-3800
Practice Address - Fax:803-744-2759
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000752207RC0000X, 207RI0011X
SC87591207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1266WOtherBCBS ID#
NC40724OtherPARTNERS ID#
NC1285682310OtherWSCA GRP NPI #
NC891266WMedicaid
VA1801876909Medicaid
NC1285682310OtherWSCA GRP NPI #
VA1801876909Medicaid
NC40724OtherPARTNERS ID#
G29578Medicare UPIN
NCNC4143AMedicare PIN