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NPI Code Detail

MEDICARE: JONATHAN D. CLEMENTE M.D.

MEDICARE: JONATHAN D. CLEMENTE M.D.
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
12085N0700XNeuroradiology Physician200200336NC
22085N0700XNeuroradiology Physician23107SC
32085R0202XDiagnostic Radiology Physician23107SC
42085R0202XDiagnostic Radiology Physician200200336NC

Other Identifiers

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

General Provider Information

NPI Number : 1578568580
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN D. CLEMENTE M.D.
Provider Business Mailing Address
First Line : 700 E MOREHEAD ST
Second Line : STE 300
City : CHARLOTTE
State : NC
Zip : 28202-2788
Country : US
Telephone Number : 704-334-7800
Fax Number : 704-414-7512
Provider Business Practice Location Address
First Line : 700 E MOREHEAD ST
Second Line : STE 300
City : CHARLOTTE
State : NC
Zip : 28202-2788
Country : US
Telephone Number : 704-334-7800
Fax Number : 704-414-7512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 12/20/2017

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Directions to “ JONATHAN D. CLEMENTE M.D.” Practice Location

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