MEDICARE: DR. MARIE A. 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
1	208000000X	Pediatrics Physician	T3934	TX
2	208000000X	Pediatrics Physician	35.123962	OH
3	2080P0006X	Developmental - Behavioral Pediatrics Physician	35.123962	OH
4	2080P0006X	Developmental - Behavioral Pediatrics Physician	T3934	TX

General Provider Information

NPI Number	:	1275739286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE A. CLARK M.D.

Provider Business Mailing Address
First Line	:	305 E 23RD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-2603
Country	:	US
Telephone Number	:	617-997-8404
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 N STADIUM DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1829
Country	:	US
Telephone Number	:	832-822-3400
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	10/29/2025

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