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General NPI Number Information
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NPI Number | 1609194596
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Entity Type | Individual
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Provider Name | CHRISTINA BLUME CLARK M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | DEPARTMENT OF RADIOLOGY UNIVERSITY OF LOUISVILLE HOSP. 530 SOUTH JACKSON STREET CCB-C07
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City | LOUISVILLE
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State | KY
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Zip | 40202-1675
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Country | US
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Telephone | 502-852-5875
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT. OF RADIOLOGY UNIVERSITY OF LOUISVILLE HOSPITAL 530 SOUTH JACKSON STREET, CCB-C07
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City | LOUISVILLE
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State | KY
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Zip | 40202
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Country | US
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Telephone | 502-852-5875
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 50602
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD461741
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License Number State | PA
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