Clontz, Ted

Clontz, Ted is an individual health care provider with primary practice located at 8401 Medical Plaza Dr Ste 365, Charlotte NC 28262-8797. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Clontz, Ted can be contacted via phone (704) 944-0975.

Contact Information

Primary practice address
8401 Medical Plaza Dr Ste 365 Charlotte NC 28262-8797
Phone: (704) 944-0975
Fax: (704) 944-3699
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 1981-25563 North Carolina
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 25563 North Carolina

Profile Details

NPI number 1639141666
LBN Legal business name Clontz, Ted
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 3rd, 2006
Last updated Mar 10th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639141666 NPPES
South Carolina MEDICAID N25563
South Carolina MEDICAID 891232H

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