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General NPI Number Information
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NPI Number | 1407858848
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Entity Type | Individual
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Provider Name | BERNARD A CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 114 WOODLAND ST CARDIOLOGY
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City | HARTFORD
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State | CT
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Zip | 06105-1208
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Country | US
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Telephone | 860-714-4161
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Fax | 860-714-8001
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Provider Business Mailing Address
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Address Line | 1000 ASYLUM AVE SUITE 2109A
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City | HARTFORD
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State | CT
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Zip | 06105-1770
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Country | US
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Telephone | 860-714-6581
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Fax | 860-714-8311
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 024602
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License Number State | CT
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