Healthcare Provider Details

I. General information

NPI: 1710636923
Provider Name (Legal Business Name): SARAH G CLARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALLY G CLARK MD

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042.0040388
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: