MEDICARE: CHARLES A CLOUTIER 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
1	2084P0800X	Psychiatry Physician	9801214	NC

General Provider Information

NPI Number	:	1841385390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A CLOUTIER M.D.

Provider Business Mailing Address
First Line	:	508 FULTON STREET
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 SUNNYBROOK ROAD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610
Country	:	US
Telephone Number	:	919-212-0129
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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