Healthcare Provider Details

I. General information

NPI: 1013029651
Provider Name (Legal Business Name): CLIFFORD GEORGE RISK M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BOLTON ST SUITE 101
MARLBOROUGH MA
01752-3980
US

IV. Provider business mailing address

320 BOLTON ST SUITE 101
MARLBOROUGH MA
01752-3980
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-4288
  • Fax: 508-624-7228
Mailing address:
  • Phone: 508-481-4288
  • Fax: 508-624-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number47576
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number47576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: