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General NPI Number Information
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NPI Number | 1437210325
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Entity Type | Organization
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Legal Business Name | WELLSBORO PEDIATRIC HEALTH CARE ASSOCIATES
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 1B MAIN STREET
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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 STREET
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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 | OWNER
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Name | BARRY A CLARK
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Credential | MD
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Telephone | 570-724-7100
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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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