MEDICARE: CLAIRE VAN EENWYK 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	207K00000X	Allergy & Immunology Physician	2009-00392	NC

General Provider Information

NPI Number	:	1174733943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE VAN EENWYK MD

Provider Business Mailing Address
First Line	:	2520 MERIDIAN PKWY
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27713-4202
Country	:	US
Telephone Number	:	919-666-4743
Fax Number	:

Provider Business Practice Location Address
First Line	:	6013 FARRINGTON RD
Second Line	:	SUITE 301
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-8172
Country	:	US
Telephone Number	:	919-962-4824
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	05/03/2016

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