Basic Information
Provider Information
NPI: 1255391991
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCLINTON
FirstName: DIANA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 60445
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282600445
CountryCode: US
TelephoneNumber: 8432373378
FaxNumber: 8432375073
Practice Location
Address1: 321 MULBERRY ST SW
Address2:  
City: LENOIR
State: NC
PostalCode: 286455720
CountryCode: US
TelephoneNumber: 8432373378
FaxNumber: 8432375073
Other Information
ProviderEnumerationDate: 03/25/2006
LastUpdateDate: 02/13/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X200000271NCY Allopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
891264005NC MEDICAID
1264001NCBCBSOTHER


Home