Healthcare Provider Details

I. General information

NPI: 1356409676
Provider Name (Legal Business Name): LINDA L. CLARK, M.D., M.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EXCHANGE BLVD SUITE LL-1
ROCHESTER NY
14608-2755
US

IV. Provider business mailing address

301 EXCHANGE BLVD SUITE LL-1
ROCHESTER NY
14608-2755
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-0072
  • Fax: 585-227-9585
Mailing address:
  • Phone: 585-227-0072
  • Fax: 585-227-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number194302
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number200001097
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number200001097
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number194302
License Number StateNY

VIII. Authorized Official

Name: DR. LINDA LEVITA CLARK
Title or Position: PRESIDENT
Credential: M.D., M.S.
Phone: 585-227-0072