Healthcare Provider Details

I. General information

NPI: 1609841048
Provider Name (Legal Business Name): CLARK A ROSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST FL 5
SAN FRANCISCO CA
94115-3465
US

IV. Provider business mailing address

200 LOTHROP ST SUITE 300, EYE & EAR INSTITUTE
PITTSBURGH PA
15213-2546
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7700
  • Fax:
Mailing address:
  • Phone: 412-647-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG152101
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD056293L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: