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NPI Code Detail

MEDICARE: DR. THOMAS V CLANCY MD

MEDICARE: DR. THOMAS V CLANCY 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
1208600000XSurgery Physician31790NC

General Provider Information

NPI Number : 1295739647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS V CLANCY MD
Provider Business Mailing Address
First Line : 2131 S 17TH ST
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7407
Country : US
Telephone Number : 910-343-0161
Fax Number :
Provider Business Practice Location Address
First Line : 2131 S 17TH ST
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7407
Country : US
Telephone Number : 910-343-0161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/09/2007

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Directions to “ DR. THOMAS V CLANCY MD” Practice Location

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