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General NPI Number Information
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NPI Number | 1023031358
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Entity Type | Individual
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Provider Name | CAROL A CLARK MD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 1130 MEDICAL ARTS BLVD SUITE 250
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City | ANDERSON
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State | IN
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Zip | 46011-3431
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Country | US
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Telephone | 765-298-4282
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Fax | 765-298-4989
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Provider Business Mailing Address
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Address Line | 1130 MEDICAL ARTS BLVD SUITE 250
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City | ANDERSON
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State | IN
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Zip | 46011-3431
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Country | US
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Telephone | 765-298-4282
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Fax | 765-298-4989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01030355A
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License Number State | IN
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