Provider Demographics
NPI:1891741013
Name:OLIVER, DAVID CLARK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARK
Last Name:OLIVER
Suffix:
Gender:M
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:PO BOX 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-634-3278
Mailing Address - Fax:252-633-3312
Practice Address - Street 1:941 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5252
Practice Address - Country:US
Practice Address - Phone:252-634-3278
Practice Address - Fax:252-633-3312
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19380207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8964037Medicaid
NC64037OtherBCBS OF NC
NC202061CMedicare PIN
NC64037OtherBCBS OF NC
NC8964037Medicaid
NC202061EMedicare PIN