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General NPI Number Information
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NPI Number | 1699186841
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Entity Type | Individual
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Provider Name | SAMANTHA CLARK MD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 830 S MAIN ST STE 101
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City | ORRVILLE
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State | OH
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Zip | 44667-2218
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Country | US
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Telephone | 330-684-4797
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Fax | 330-684-4759
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Provider Business Mailing Address
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Address Line | 7570 BONETA RD
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City | WADSWORTH
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State | OH
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Zip | 44281-8403
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Country | US
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Telephone | 330-419-1019
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 35.132336
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License Number State | OH
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