Individual
DR. KEITH MONTGOMERY CLANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 N ELAM AVE, GREENSBORO, NC 27403-1127
(336) 547-1801
(336) 547-1828
Mailing address
1200 N ELM ST, GREENSBORO, NC 27401-1004
(336) 832-7000
(336) 547-1828
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35110
NC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
35110
NC
207RP1001X
Pulmonary Disease Physician
Primary
35110
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1880
PARTNERS MEDICARE PROV #
NC
01
—
22503
BCBS NC PROVIDER NUMBER
NC
01
—
4230049
AETNA PROVIDER NUMBER
NC
01
—
67906
MEDCOST PROVIDER NUMBER
NC
05
—
8922503
—
NC
Enumeration date
04/06/2006
Last updated
12/05/2012
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