MEDICARE: CLARENCE E PEARSON 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
1	207RC0000X	Cardiovascular Disease Physician	0101033368	VA
2	207RC0000X	Cardiovascular Disease Physician	2003-0352	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1083618987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE E PEARSON 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	:	540-224-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107B BROOKDALE ST
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-4501
Country	:	US
Telephone Number	:	276-634-4400
Fax Number	:	276-638-2900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/07/2023

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