Healthcare Provider Details

I. General information

NPI: 1346621679
Provider Name (Legal Business Name): ALICIA MCCLINTOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CTR
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

3506 W TYVOLA RD
CHARLOTTE NC
28208-7201
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9795
  • Fax: 619-532-7508
Mailing address:
  • Phone: 704-329-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number201601647
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: