Healthcare Provider Details

I. General information

NPI: 1871546721
Provider Name (Legal Business Name): CLARK WILLIAM PINYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 LEWISVILLE CLEMMONS RD
CLEMMONS NC
27012-8905
US

IV. Provider business mailing address

PO BOX 602658
CHARLOTTE NC
28260-2658
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4101
  • Fax:
Mailing address:
  • Phone: 336-716-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2000-01245
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: