Healthcare Provider Details

I. General information

NPI: 1215626957
Provider Name (Legal Business Name): ALDEN CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

525 EHRINGHAUS ST
HENDERSONVILLE NC
28739-4117
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-4972
  • Fax: 202-444-7333
Mailing address:
  • Phone: 828-808-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200002204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: