MEDICARE: DAVID CLARK JR. 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
1	207Q00000X	Family Medicine Physician	0101284104	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1154385086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CLARK JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 791775
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-1775
Country	:	US
Telephone Number	:	571-302-5000
Fax Number	:	571-302-5001

Provider Business Practice Location Address
First Line	:	6218 N KINGS HWY STE B
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-2442
Country	:	US
Telephone Number	:	571-560-2621
Fax Number	:	571-560-2622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	05/05/2026

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Directions to “ DAVID CLARK JR. M.D.” Practice Location

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