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General NPI Number Information
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NPI Number | 1376507772
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Entity Type | Individual
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Provider Name | LINDA CLARK MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 13 SAINT ALBANS CIR SUITE C
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-3622
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Country | US
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Telephone | 484-422-8647
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Fax | 484-422-8648
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Provider Business Mailing Address
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Address Line | 13 SAINT ALBANS CIR SUITE C
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-3622
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Country | US
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Telephone |
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Fax |
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD059952L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | MD059952L
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License Number State | PA
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