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NPI Code Detail

MEDICARE: MARTHA CLARK

MEDICARE: MARTHA CLARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1003410028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA CLARK
Provider Business Mailing Address
First Line : 382 BROADWAY AVE
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-0364
Country : US
Telephone Number : 304-599-7743
Fax Number :
Provider Business Practice Location Address
First Line : 382 BROADWAY AVE
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-0364
Country : US
Telephone Number : 304-599-7743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2020
Last Update Date : 11/30/2020

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Directions to “ MARTHA CLARK ” Practice Location

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