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General NPI Number Information
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NPI Number | 1982337242
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Entity Type | Organization
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Legal Business Name | CLARK PULMONARY GROUP
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location 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 | 757-818-4995
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Provider Business Mailing Address
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Address Line | 3575 BRIDGE ROAD SUITE 8; #611
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City | SUFFOLK
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State | VA
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Zip | 23435
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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 PIERRE 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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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