Healthcare Provider Details

I. General information

NPI: 1427026210
Provider Name (Legal Business Name): STEPHEN B CLYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10512 PARK RD SUITE 200
CHARLOTTE NC
28210-8475
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 704-295-3000
  • Fax: 704-838-8494
Mailing address:
  • Phone: 704-295-3000
  • Fax: 704-838-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2002-01229
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: