Healthcare Provider Details

I. General information

NPI: 1598877995
Provider Name (Legal Business Name): DEBRA STEIN CLANCY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BROWN ST
WASHINGTON NC
27889-4671
US

IV. Provider business mailing address

450 COX RD
WASHINGTON NC
27889-9264
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-4134
  • Fax: 252-946-2432
Mailing address:
  • Phone: 252-946-4134
  • Fax: 252-946-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9500511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: