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General NPI Number Information
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NPI Number | 1477247864
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Entity Type | Organization
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Legal Business Name | CLARK INFECTIOUS DISEASE GROUP
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 2501 PARKERS LN FL 4
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3209
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Country | US
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Telephone | 703-664-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WATCH HARBOUR CT
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City | SUFFOLK
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State | VA
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Zip | 23435-3179
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Country | US
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Telephone | 757-582-1629
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR P CLARK
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Credential | MD
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Telephone | 757-582-1629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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