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NPI Code Detail

MEDICARE: AMY S CLARK MD

MEDICARE: AMY S 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
1207R00000XInternal Medicine PhysicianMD440306PA
2207RX0202XMedical Oncology PhysicianMD440306PA

General Provider Information

NPI Number : 1356518724
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY S CLARK MD
Provider Business Mailing Address
First Line : 3400 CIVIC CENTER BOULEVARD
Second Line : DEPT OF HEMATOLOGY & ONCOLOGY
City : PHILADELPHIA
State : PA
Zip : 19104-4204
Country : US
Telephone Number : 215-615-5858
Fax Number :
Provider Business Practice Location Address
First Line : 3400 CIVIC CENTER BOULEVARD
Second Line : DEPT OF HEMATOLOGY & ONCOLOGY
City : PHILADELPHIA
State : PA
Zip : 19104-4204
Country : US
Telephone Number : 215-615-5858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2008
Last Update Date : 08/22/2019

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