Individual
CHARLES RANDALL CLINCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200000381
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10060869
—
VA
01
—
126KG
BCBS
NC
05
—
3810010791
—
WV
01
—
7816219
AETNA
NC
01
—
807178
PARTNERS
NC
05
—
89126KG
—
NC
01
—
97761
MEDCOST
NC
Enumeration date
11/30/2005
Last updated
03/25/2014
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