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NPI Code Detail

MEDICARE: ANDREW RYAN CLARK M.D.

MEDICARE: ANDREW RYAN CLARK M.D.
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
12084P0800XPsychiatry PhysicianMD439197PA
22084P0804XChild & Adolescent Psychiatry PhysicianMD439197PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LL27954OTHERSCLICENSE
2MD439197OTHERPALICENSE
3058450OTHERGALICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033200506
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW RYAN CLARK M.D.
Provider Business Mailing Address
First Line : 5300 KIDSPEACE DR
Second Line :
City : OREFIELD
State : PA
Zip : 18069-2044
Country : US
Telephone Number : 610-799-8853
Fax Number : 610-799-8001
Provider Business Practice Location Address
First Line : 5300 KIDSPEACE DR
Second Line :
City : OREFIELD
State : PA
Zip : 18069-2044
Country : US
Telephone Number : 610-799-8000
Fax Number : 610-799-8801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/21/2022

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