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NPI Code Detail

MEDICARE: DAVID C CLARK MD

MEDICARE: DAVID C 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
1207Q00000XFamily Medicine Physician165574NY

General Provider Information

NPI Number : 1841380870
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID C CLARK MD
Provider Business Mailing Address
First Line : 2209 GENESEE STREET
Second Line : BUSINESS OFFICE ROOM 315
City : UTICA
State : NY
Zip : 13501-5930
Country : US
Telephone Number : 315-801-3282
Fax Number : 315-801-8391
Provider Business Practice Location Address
First Line : 8411 SENECA TPKE
Second Line :
City : NEW HARTFORD
State : NY
Zip : 13413-4912
Country : US
Telephone Number : 315-624-8500
Fax Number : 315-624-8515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 02/11/2020

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