Basic Information
| Provider Information | |||||||||
| NPI: | 1427026210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLYNE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Practice Location | |||||||||
| Address1: | 10512 PARK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2002-01229 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 20079900 | 01 | SC | SELECT HEALTH OF SC | OTHER | 772913 | 01 | SC | WELLCARE | OTHER | N0122A | 05 | SC | MEDICAID | 4823670 | 01 | NC | CIGNA | OTHER | 7368564 | 01 | NC | AETNA | OTHER | 80401 | 01 | SC | CHCCARES OF SC | OTHER | 1377K | 01 | NC | BCBS | OTHER | 3476629 | 01 | NC | AETNA HMO/EPO/SELECT | OTHER | D3210 | 01 | NC | MEDCOST | OTHER | 2422065 | 01 | NC | UNITED HEALTHCARE | OTHER | 891377 | 05 | NC | MEDICAID |