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NPI Code Detail

MEDICARE: CLIFFORD NOTTINGHAM MD

MEDICARE: CLIFFORD NOTTINGHAM 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
1207Q00000XFamily Medicine Physician0101-030966VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942272083
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLIFFORD NOTTINGHAM MD
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number : 540-224-5715
Fax Number :
Provider Business Practice Location Address
First Line : 6415 PETERS CREEK RD
Second Line :
City : ROANOKE
State : VA
Zip : 24019-4021
Country : US
Telephone Number : 540-265-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 08/10/2022

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