Provider Demographics
NPI:1811086390
Name:CLANCY, MICHELE (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CLANCY
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 1:1414 PHYSICIANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7335
Mailing Address - Country:US
Mailing Address - Phone:910-796-7900
Mailing Address - Fax:910-796-7901
Practice Address - Street 1:1406 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7335
Practice Address - Country:US
Practice Address - Phone:910-762-9422
Practice Address - Fax:910-341-3014
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911324Medicaid
NC2250867AMedicare ID - Type UnspecifiedPART B
NC8911324Medicaid