MEDICARE: CHARLES CLEMMENSEN M.D.

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	207N00000X	Dermatology Physician	3757	NV
2	207ND0101X	MOHS-Micrographic Surgery Physician	3757	NV
3	207ND0900X	Dermatopathology Physician	3757	NV
4	207NS0135X	Procedural Dermatology Physician	3757	NV
5	207R00000X	Internal Medicine Physician	3757	NV

General Provider Information

NPI Number	:	1871551747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES CLEMMENSEN M.D.

Provider Business Mailing Address
First Line	:	1100 S CARSON ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5232
Country	:	US
Telephone Number	:	775-883-7811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S CARSON ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5232
Country	:	US
Telephone Number	:	775-883-7811
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	09/11/2025

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