Provider Demographics
NPI:1699713065
Name:VAN CLEEFF, ASHLAN SABINE (MD)
Entity type:Individual
Prefix:
First Name:ASHLAN SABINE
Middle Name:
Last Name:VAN CLEEFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDER
Other - Middle Name:
Other - Last Name:VAN CLEEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 FAULK ST
Practice Address - Street 2:STE 3100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5086
Practice Address - Country:US
Practice Address - Phone:704-667-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701178207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00612319OtherRAILROAD MEDICARE
NC891049XMedicaid
NC1049XOtherBCBS
SC169454Medicaid
NC1699713065Medicaid
NC2248950FMedicare PIN
SC169454Medicaid
NC2248950DMedicare PIN
SCF921367772Medicare PIN
NCP00612319OtherRAILROAD MEDICARE
NC1049XOtherBCBS
NC891049XMedicaid
NC2248950Medicare PIN
SCF921365332Medicare PIN