Provider Demographics
NPI:1861614430
Name:HOWARD, CLIFFORD JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:
Last Name:HOWARD
Suffix:JR
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 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:DIVISION OF RADIOLOGIC SCIENCES
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-7095
Practice Address - Fax:336-713-4267
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004006832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023817Medicaid
VA1861614430Medicaid
SCQ83004Medicaid
NC200400683OtherLICENSE
NC5906705Medicaid
NC200400683OtherLICENSE