MEDICARE: RICHARD B CLINTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	2009-00030	NC
2	2085R0202X	Diagnostic Radiology Physician	31521	SC
3	2085R0202X	Diagnostic Radiology Physician	052158	GA
4	2085R0204X	Vascular & Interventional Radiology Physician	31521	SC

General Provider Information

NPI Number	:	1699769315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD B CLINTON MD

Provider Business Mailing Address
First Line	:	1121 SITUS CT STE 170
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-4279
Country	:	US
Telephone Number	:	919-834-2767
Fax Number	:	919-834-0234

Provider Business Practice Location Address
First Line	:	3200 BLUE RIDGE RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8087
Country	:	US
Telephone Number	:	919-781-1437
Fax Number	:	919-787-4870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	01/23/2019

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