MEDICARE: JOSEPH D CLARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD055948L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194795856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH D CLARK M.D.

Provider Business Mailing Address
First Line	:	81 HILLCREST DR STE 1300
Second Line	:
City	:	PUNXSUTAWNEY
State	:	PA
Zip	:	15767-2605
Country	:	US
Telephone Number	:	814-938-5910
Fax Number	:	814-938-4525

Provider Business Practice Location Address
First Line	:	81 HILLCREST DR STE 1300
Second Line	:
City	:	PUNXSUTAWNEY
State	:	PA
Zip	:	15767-2605
Country	:	US
Telephone Number	:	814-938-5910
Fax Number	:	814-938-4525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	02/17/2020

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