MEDICARE: CLARK KERR

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	MD024104E	PA

General Provider Information

NPI Number	:	1295702645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARK KERR

Provider Business Mailing Address
First Line	:	13200 PROVIDENCE LN
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-2874
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12279 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-1876
Country	:	US
Telephone Number	:	724-864-7101
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	05/24/2021

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Directions to “ CLARK KERR ” Practice Location

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