MEDICARE: DR. DEVIN 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
1	207R00000X	Internal Medicine Physician	P107563	NY

General Provider Information

NPI Number	:	1760915425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVIN CLARK MD

Provider Business Mailing Address
First Line	:	3438 BELL BLVD STE 301
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1739
Country	:	US
Telephone Number	:	187-709-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 TELLER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-4291
Country	:	US
Telephone Number	:	718-293-1500
Fax Number	:

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

Provider Enumeration Date	:	04/09/2017
Last Update Date	:	10/16/2024

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