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NPI Code Detail

MEDICARE: TERRANCE P CLARK MD

MEDICARE: TERRANCE P CLARK MD
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 PhysicianMD34832TN
22084P0800XPsychiatry Physician20250NC

Other Identifiers

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

General Provider Information

NPI Number : 1225022551
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRANCE P CLARK MD
Provider Business Mailing Address
First Line : 44 BONNIE LN
Second Line :
City : SYLVA
State : NC
Zip : 28779-8511
Country : US
Telephone Number : 828-586-5501
Fax Number : 828-586-3965
Provider Business Practice Location Address
First Line : 91 TIMBERLANE DRIVE
Second Line :
City : WAYNESVILLE
State : NC
Zip : 28786-7927
Country : US
Telephone Number : 828-454-1098
Fax Number : 828-454-9242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 12/19/2011

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