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NPI Code Detail

MEDICARE: KEVIN R CLARK DO

MEDICARE: KEVIN R CLARK DO
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
1208D00000XGeneral Practice Physician200300020NC
2207P00000XEmergency Medicine Physician200300020NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00251742OTHERNCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21293COTHERNCBCBS

General Provider Information

NPI Number : 1053373399
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN R CLARK DO
Provider Business Mailing Address
First Line : PO BOX 60359
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0359
Country : US
Telephone Number : 843-237-3378
Fax Number : 843-237-5073
Provider Business Practice Location Address
First Line : 420 N CENTER ST
Second Line :
City : HICKORY
State : NC
Zip : 28601-5046
Country : US
Telephone Number : 843-237-3378
Fax Number : 843-237-5073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 06/08/2026

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Directions to “ KEVIN R CLARK DO” Practice Location

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