Provider Demographics
NPI:1194847707
Name:CLAREY, KRISTEN SAMUHEL (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SAMUHEL
Last Name:CLAREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:SAMUHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 604337
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260
Mailing Address - Country:US
Mailing Address - Phone:919-238-2000
Mailing Address - Fax:919-238-5010
Practice Address - Street 1:3700 NW CARY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8446
Practice Address - Country:US
Practice Address - Phone:919-238-2000
Practice Address - Fax:919-238-5010
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00406207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZR0000117Medicare UPIN