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General NPI Number Information
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NPI Number | 1396786133
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Entity Type | Individual
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Provider Name | LEEROY MARK CLARKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3001 HOSPITAL DR
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City | CHEVERLY
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State | MD
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Zip | 20785-1189
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Country | US
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Telephone | 301-618-6100
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Fax |
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Provider Business Mailing Address
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Address Line | STERLING ANESTHESIA OF MARYLAND P.O. BOX 822360
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City | PHILADELPHIA
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State | PA
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Zip | 19182-0001
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Country | US
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Telephone | 410-793-0791
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Fax | 410-793-0809
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0056346
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License Number State | MD
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