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General NPI Number Information
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NPI Number | 1740336080
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Entity Type | Individual
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Provider Name | JAMES KENNETH SEFFINGA CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR
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City | LEBANON
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State | NH
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Zip | 03756-0001
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Country | US
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Telephone | 603-650-5000
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Fax |
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Provider Business Mailing Address
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Address Line | NAVAL MEDICAL CENTER PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
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City | PORTSMOUTH
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State | VA
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Zip | 23708-1904
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Country | US
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Telephone | 619-709-5003
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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 | 34260
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License Number State | NH
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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 | 24426
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License Number State | NE
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