Provider Demographics
NPI:1154428100
Name:MCCLERKLIN, PATRICIA A (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MCCLERKLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6503
Mailing Address - Country:US
Mailing Address - Phone:803-771-9163
Mailing Address - Fax:803-771-7383
Practice Address - Street 1:112 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6503
Practice Address - Country:US
Practice Address - Phone:803-771-9163
Practice Address - Fax:803-771-7383
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3032Medicaid
SCD175130281Medicare ID - Type Unspecified
D17513Medicare UPIN