Healthcare Provider Details

I. General information

NPI: 1891013967
Provider Name (Legal Business Name): ALLEN RICHARD CLARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MEDICAL CENTER DR STE 2700
BRUNSWICK ME
04011-2669
US

IV. Provider business mailing address

121 MEDICAL CENTER DR STE 2700
BRUNSWICK ME
04011-2669
US

V. Phone/Fax

Practice location:
  • Phone: 207-721-8700
  • Fax: 207-536-6719
Mailing address:
  • Phone: 207-721-8700
  • Fax: 207-536-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD29198
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD29198
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: