Provider Demographics
NPI:1124382056
Name:CLAVELL, CHRISTINE ISABEL (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ISABEL
Last Name:CLAVELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4411 THE 25 WAY NE STE 325
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5853
Practice Address - Country:US
Practice Address - Phone:505-823-4411
Practice Address - Fax:505-343-6085
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2017-0899207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist