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NPI Code Detail

MEDICARE: DAVID CLARK JR. M.D.

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
1207Q00000XFamily Medicine Physician31461NC
2207P00000XEmergency Medicine PhysicianMD 03952DC
3207P00000XEmergency Medicine PhysicianD0067329MD

Other Identifiers

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 : 2305 OBERWOOD DRIVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270
Country : US
Telephone Number : 704-241-8853
Fax Number :
Provider Business Practice Location Address
First Line : 1310 SOUTHERN AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-4623
Country : US
Telephone Number : 202-574-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 09/26/2011

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