Healthcare Provider Details

I. General information

NPI: 1831320431
Provider Name (Legal Business Name): PAUL ALBERT CLARK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 02/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4191
  • Fax: 301-319-2993
Mailing address:
  • Phone: 301-400-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0102202876
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0102202876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: