Provider Demographics
NPI:1831398411
Name:WASHINGTON, CLARENCE J III (MD)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:J
Last Name:WASHINGTON
Suffix:III
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 1:700 E HEBRON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5993
Mailing Address - Country:US
Mailing Address - Phone:704-551-0808
Mailing Address - Fax:
Practice Address - Street 1:700 E HEBRON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5993
Practice Address - Country:US
Practice Address - Phone:704-551-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32295207V00000X
GA024879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBW7385544OtherDEA