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NPI Code Detail

MEDICARE: MR. MARK STEVEN CLARK PA

MEDICARE: MR. MARK STEVEN CLARK PA
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
1363A00000XPhysician Assistant0362NH
2363AM0700XMedical Physician Assistant0362NH

Other Identifiers

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

General Provider Information

NPI Number : 1235115213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK STEVEN CLARK PA
Provider Business Mailing Address
First Line : 38 CORTLAND DR
Second Line :
City : BEDFORD
State : NH
Zip : 03110-4224
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 VERNEY DRIVE
Second Line :
City : GREENFIELD
State : NH
Zip : 03047
Country : US
Telephone Number : 603-305-0628
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 03/18/2014

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Directions to “ MR. MARK STEVEN CLARK PA” Practice Location

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