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General NPI Number Information
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NPI Number | 1538115423
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Entity Type | Individual
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Provider Name | MICHAEL B CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 2002 MEDICAL PKWY STE 235
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3046
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Country | US
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Telephone | 410-266-2770
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Fax | 410-841-6251
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Provider Business Mailing Address
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Address Line | 2002 MEDICAL PKWY STE 235
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3046
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Country | US
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Telephone | 410-266-2770
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Fax | 410-841-6251
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | D0056183
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | D0056183
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.080358
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD416976
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200000198
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 28302
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License Number State | SC
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Taxonomy #7
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME94700
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License Number State | FL
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