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General NPI Number Information
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NPI Number | 1336249341
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Entity Type | Individual
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Provider Name | BARRY A CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 1B MAIN ST
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City | WELLSBORO
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State | PA
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Zip | 16901-1601
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Country | US
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Telephone | 570-724-7100
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Fax | 570-724-1501
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Provider Business Mailing Address
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Address Line | 1B MAIN ST
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City | WELLSBORO
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State | PA
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Zip | 16901-1601
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Country | US
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Telephone | 570-724-7100
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Fax | 570-724-1501
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD029130E
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License Number State | PA
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