MEDICARE: DR. MARK A CLARKSON D.O.

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	2175	WV

General Provider Information

NPI Number	:	1508886987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A CLARKSON D.O.

Provider Business Mailing Address
First Line	:	200 HEALTH CENTER DRIVE
Second Line	:	PO BOX 590
City	:	UNION
State	:	WV
Zip	:	24983
Country	:	US
Telephone Number	:	304-772-3064
Fax Number	:	304-772-3296

Provider Business Practice Location Address
First Line	:	2869 SENECA TRIAL
Second Line	:
City	:	PETERSTOWN
State	:	WV
Zip	:	24963
Country	:	US
Telephone Number	:	304-753-4336
Fax Number	:	304-753-4097

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/18/2015

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